Mortality Risk Stratification in Elderly Trauma Patients Based on Initial Arterial Lactate and Base Deficit Levels

被引:0
作者
Neville, Angela L. [1 ]
Nemtsev, Denis [1 ]
Manasrah, Raed [1 ]
Bricker, Scott D. [1 ]
Putnam, Brant A. [1 ]
机构
[1] Harbor UCLA Med Ctr, Dept Surg, Torrance, CA 90509 USA
关键词
GERIATRIC TRAUMA; INJURY; HYPOTENSION; MANAGEMENT; UTILITY; OLD;
D O I
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中图分类号
R61 [外科手术学];
学科分类号
摘要
Elderly trauma patients have worse outcomes than their younger counterparts. Early risk stratification remains difficult, particularly because traditional vital signs are less reliable. We hypothesized that arrival lactate and base deficit (BD) could be used to predict mortality in elderly trauma patients with a normal admission blood pressure. We retrospectively evaluated the prospectively collected trauma registry at our urban Level I trauma center between 2003 and 2009. Patients sustaining blunt trauma, age 55 years or older, with a systolic blood pressure 90 mmHg or higher, and who had arterial lactate and/or BD measured within 4 hours of arrival comprised the study group. Primary outcomes were in-hospital and 24-hour mortality. There were 364 patients with a lactate and 324 with a BD drawn. Patients with a lactate 2.5 mmol or greater were 3.7 times more likely to die than those with a lactate less than 2.5 mmol (95% CI, 1.6 to 8.2; P = 0.0018). The OR for mortality was 5.2 (95% CI, 2.5 to 11.2; P < 0.0001) in patients with a BD -4 or less. Elevated lactate and BD were even stronger predictors of early mortality (within first 24 hours). After increasing the hypotension threshold to a systolic blood pressure 110 mmHg or greater, lactate and BD remained highly predictive of in-hospital and 24-hour mortality.
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页码:1337 / 1341
页数:5
相关论文
共 18 条
  • [1] Prehospital Hypotension Redefined
    Bruns, Brandon
    Gentilello, Larry
    Elliott, Alan
    Shafi, Shahid
    [J]. JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2008, 65 (06): : 1217 - 1221
  • [2] Serum Lactate and Base Deficit as Predictors of Mortality in Normotensive Elderly Blunt Trauma Patients
    Callaway, David W.
    Shapiro, Nathan I.
    Donnino, Michael W.
    Baker, Christopher
    Rosen, Carlo L.
    [J]. JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2009, 66 (04): : 1040 - 1044
  • [3] A Different View of Lactate in Trauma Patients: Protecting the Injured Brain
    Cureton, Elizabeth L.
    Kwan, Rita O.
    Dozier, Kristopher C.
    Sadjadi, Javid
    Pal, Jay D.
    Victorino, Gregory P.
    [J]. JOURNAL OF SURGICAL RESEARCH, 2010, 159 (01) : 468 - 473
  • [4] Base deficit in the elderly: A marker of severe injury and death
    Davis, JW
    Kaups, KL
    [J]. JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1998, 45 (05) : 873 - 877
  • [5] Day J.C., 1996, POPULATION PROJECTIO
  • [6] Effect on outcome of early intensive management of geriatric trauma patients
    Demetriades, D
    Karaiskakis, M
    Velmahos, G
    Alo, K
    Newton, E
    Murray, J
    Asensio, J
    Belzberg, H
    Berne, T
    Shoemaker, W
    [J]. BRITISH JOURNAL OF SURGERY, 2002, 89 (10) : 1319 - 1322
  • [7] Old age as a criterion for trauma team activation
    Demetriades, D
    Sava, J
    Alo, K
    Newton, E
    Velmahos, GC
    Murray, JA
    Belzberg, H
    Asensio, JA
    Berne, TV
    [J]. JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2001, 51 (04): : 754 - 756
  • [8] Lactate and base deficit in trauma: Does alcohol or drug use impair their predictive accuracy?
    Dunne, JR
    Tracy, JK
    Scalea, TM
    Napolitano, LM
    [J]. JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2005, 58 (05): : 959 - 966
  • [9] Hypotension begins at 110 mm Hg: Redefining "Hypotension" with data
    Eastridge, Brian J.
    Salinas, Jose
    McManus, John G.
    Blackburn, Lome
    Bugler, Eileen M.
    Cooke, William H.
    Concertino, Victor A.
    Wade, Charles E.
    Holcomb, John B.
    [J]. JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2007, 63 (02): : 291 - 297
  • [10] Edwards M, 2010, AM SURGEON, V76, P1035