Admission lactate as a rule-in predictor of severe pediatric trauma in an Arizona trauma center

Abstract

Purpose: Pediatric trauma is a leading cause of mortality among children. A high lactate concentration is a well-established prognostic indicator for severe trauma in adults, but evidence is lacking in children. Methods: A retrospective review was performed on patients aged 0-17 years who underwent trauma activations at an urban medical center in Arizona from 2010 through 2020. Data were collected on demographics, injury mechanisms, admission lactate values, Glasgow Coma Scale, Injury Severity Score, hospital length of stay, and severe trauma. The severe trauma was defined as in-hospital mortality, or need for blood transfusion or emergency surgical interventions. Results: Of 566 patients, 53 (9.4%) had severe trauma, of whom 11 (1.9%) died, 32 (5.7%) underwent blood transfusions, and 32 (5.7%) underwent emergency surgical interventions. Patients with severe trauma had a significantly higher median lactate concentration than those without severe trauma (2.5 mmol/L [interquartile range, 1.9-3.8] vs. 1.7 mmol/L [1.2-2.4]; P < 0.001). An optimal lactate cutoff was 1.9 showed an area under the curve of 0.69 (95% confidence interval, 0.61-0.77), resulting in a maximal combined sensitivity (75.4%) and specificity (57.9%). As a lactate cutoff increased from 1.0 to 6.0 mmol/L, the specificity increased from 9.2% to 98.8%, while the sensitivity decreased from 96.2% to 13.2% for predicting severe trauma. Admission lactate was correlated negatively with Glasgow Coma Scale (Spearman’s rho = - 0.134; P = 0.001) and positively with Injury Severity Score (0.130; P = 0.002), while not correlated with hospital length of stay (0.070; P = 0.096). Conclusion: Admission lactate has a high specificity for severe trauma in children at the cost of sensitivity. It should be used in conjunction with other screening tools when ruling out severe trauma.