Admission lactate as a rule-in predictor of severe pediatric trauma in an Arizona trauma center
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 tr...
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Korean Society of Pediatric Emergency Medicine
2025-07-01
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| Series: | Pediatric Emergency Medicine Journal |
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| Online Access: | http://pemj.org/upload/pdf/pemj-2025-01305.pdf |
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| author | Zola Trotter Eric Jackson Shailesh Khetarpal Bikash Bhattarai Katherine Barlow Colin Hurkett Kevin Foster |
| author_facet | Zola Trotter Eric Jackson Shailesh Khetarpal Bikash Bhattarai Katherine Barlow Colin Hurkett Kevin Foster |
| author_sort | Zola Trotter |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-b31e60d1dd2346089fe34f024bafdab0 |
| institution | Kabale University |
| issn | 2383-4897 2508-5506 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Korean Society of Pediatric Emergency Medicine |
| record_format | Article |
| series | Pediatric Emergency Medicine Journal |
| spelling | doaj-art-b31e60d1dd2346089fe34f024bafdab02025-08-20T03:33:41ZengKorean Society of Pediatric Emergency MedicinePediatric Emergency Medicine Journal2383-48972508-55062025-07-0112310311110.22470/pemj.2025.01305240Admission lactate as a rule-in predictor of severe pediatric trauma in an Arizona trauma centerZola Trotter0Eric Jackson1Shailesh Khetarpal2Bikash Bhattarai3Katherine Barlow4Colin Hurkett5Kevin Foster6Department of Pediatrics, Valleywise Health Medical Center, Phoenix, AZ, USADoctor of Medicine Program, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USADepartment of Pediatrics, Valleywise Health Medical Center, Phoenix, AZ, USADepartment of Biostatistics, Valleywise Health Medical Center, Phoenix, AZ, USADoctor of Medicine Program, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USADoctor of Medicine Program, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USADepartment of Surgery, Valleywise Health Medical Center, Phoenix, AZ, USAPurpose 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.http://pemj.org/upload/pdf/pemj-2025-01305.pdfblood transfusioncraniocerebral traumalactic acidpediatric emergency medicineroc curvewounds and injuries |
| spellingShingle | Zola Trotter Eric Jackson Shailesh Khetarpal Bikash Bhattarai Katherine Barlow Colin Hurkett Kevin Foster Admission lactate as a rule-in predictor of severe pediatric trauma in an Arizona trauma center Pediatric Emergency Medicine Journal blood transfusion craniocerebral trauma lactic acid pediatric emergency medicine roc curve wounds and injuries |
| title | Admission lactate as a rule-in predictor of severe pediatric trauma in an Arizona trauma center |
| title_full | Admission lactate as a rule-in predictor of severe pediatric trauma in an Arizona trauma center |
| title_fullStr | Admission lactate as a rule-in predictor of severe pediatric trauma in an Arizona trauma center |
| title_full_unstemmed | Admission lactate as a rule-in predictor of severe pediatric trauma in an Arizona trauma center |
| title_short | Admission lactate as a rule-in predictor of severe pediatric trauma in an Arizona trauma center |
| title_sort | admission lactate as a rule in predictor of severe pediatric trauma in an arizona trauma center |
| topic | blood transfusion craniocerebral trauma lactic acid pediatric emergency medicine roc curve wounds and injuries |
| url | http://pemj.org/upload/pdf/pemj-2025-01305.pdf |
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