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Added predictive value of prehospital measurement of point-of-care lactate in an adult general EMS population in Sweden: a multi-centre observational study
University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. (PreHospen)
University of Borås, Faculty of Caring Science, Work Life and Social Welfare. (PreHospen)ORCID iD: 0000-0003-4139-6235
University of Borås, Faculty of Caring Science, Work Life and Social Welfare. (PreHospen)ORCID iD: 0000-0001-6505-9132
Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
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2024 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 32, article id 72Article in journal (Refereed) Published
Abstract [en]

Background

Emergency medical services (EMS) personnel must rapidly assess and transport patients with time-sensitive conditions to optimise patient outcomes. Serum lactate, a valuable in-hospital biomarker, has become more accessible in EMS settings through point-of-care (POC) testing. Although POC lactate levels are valuable in specific patient groups, its broader application in EMS remains unclear. This study assessed the additional predictive value of POC lactate levels in a general adult EMS population.

Methods

This prospective observational study (March 2018 to September 2019) involved two EMS organisations in Västra Götaland, Sweden. Patients were triaged using the Rapid Triage and Treatment System (RETTS). POC lactate levels were measured using StatStrip Xpress devices. Non-consecutive patients who received EMS and were aged 18 years and above were available for inclusion if triaged into RETTS levels: red, orange, yellow, or green if respiratory rate of ≥ 22 breaths/min. Outcomes were adverse outcomes, including a time-sensitive diagnosis, sequential organ failure assessment (SOFA) score ≥ 2, and 30-day mortality. Statistical analyses included descriptive statistics, imputation, and regression models to assess the impact of the addition of POC lactate levels to a base model (comprising patient age, sex, presence of past medical conditions, vital signs, pain, EMS response time, assessed triage condition, and triage level) and a RETTS triage model.

Results

Of 4,546 patients (median age 75 [57, 84] years; 49% male), 32.4% had time-sensitive conditions, 12.5% met the SOFA criteria, and 7.4% experienced 30-day mortality. The median POC lactate level was 1.7 (1.2, 2.5) mmol/L. Patients with time-sensitive conditions had higher lactate levels (1.9 mmol/L) than those with non-time-sensitive conditions (1.6 mmol/L). The probability of a time-sensitive condition increased with increasing lactate level. The addition of POC lactate marginally enhanced the predictive models, with a 1.5% and 4% increase for the base and RETTS triage models, respectively. POC lactate level as a sole predictor showed chance-only level predictive performance.

Conclusions

Prehospital POC lactate assessment provided limited additional predictive value in a general adult EMS population. However, it may be beneficial in specific patient subgroups, emphasizing the need for its judicious use in prehospital settings.

Place, publisher, year, edition, pages
Springer Nature, 2024. Vol. 32, article id 72
Keywords [en]
Prehospital, Point-of-care, Patient assessment, Emergency medical service, Lactate
National Category
Clinical Medicine Health Sciences
Research subject
The Human Perspective in Care; The Human Perspective in Care
Identifiers
URN: urn:nbn:se:hb:diva-32400DOI: 10.1186/s13049-024-01245-7ISI: 001294460500002Scopus ID: 2-s2.0-85201529730OAI: oai:DiVA.org:hb-32400DiVA, id: diva2:1891432
Available from: 2024-08-22 Created: 2024-08-22 Last updated: 2024-11-07Bibliographically approved

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Herlitz, JohanAxelsson, ChristerOlander, AgnesAndersson Hagiwara, Magnus

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