Send to

Choose Destination
J Emerg Trauma Shock. 2019 Jul-Sep;12(3):203-208. doi: 10.4103/JETS.JETS_120_18.

Predictive Value of Point-of-care Lactate Measurement in Patients Meeting Level II and III Trauma Team Activation Criteria that Present to the Emergency Department: A Prospective Study.

Author information

Department of Emergency Medicine, CHRISTUS Health/Texas A and M Health Science Center, Corpus Christi, TX, USA.
Department of Acute Care Surgery, Trauma and Surgical Critical Care, Christus Spohn Hospital, Corpus Christi, TX, USA.



The aim of this study was to investigate the utility of early point-of-care (POC) lactate levels to help predict injury severity and ultimate emergency department (ED) disposition for trauma patients meeting Level II and III activation criteria.


This was a blinded, prospective cohort study including a convenience sample of patients meeting our triage criteria for Level II or III team activation with stable vital signs. Bedside lactate samples were collected during the secondary survey. Clinical care/disposition was at the discretion of physicians who remained blinded to the bedside lactate result. An elevated lactate was defined as >2.0 mmol/L.


Ninety-six patients were in the study group; mean age was 41 ± 17 years, 26% were female, 57% were Hispanic, and 60% admitted. We found no difference in initial mean POC lactate levels (mmol/L) for admitted versus discharged groups and Injury Severity Score (ISS) ≥9 versus ISS <9 groups (3.71 [95% confidence interval (CI): 3.1-4.4] vs. 3.85 [95% CI: 2.8-4.9]; P = 0.99 and 3.54 [95% CI: 2.7-4.4] vs. 3.89 [95% CI: 3.1-4.6]; P = 0.60, respectively). Performance characteristics of early elevated lactate levels were poor both to predict need for hospital admission (sensitivity = 77% [65%-87%]; specificity = 26% [13%-43%]; negative predictive value [NPV] = 43% [27%-61%]; and positive predictive value [PPV] = 62% [56%-67%]) and to identify patients with ISS scores ≥9 (sensitivity = 76% [59%-89%]; specificity = 24% [14%-37%]; NPV = 65% [47%-80%]; and PPV = 36% [30%-41%]).


For Level II/III, we found that early bedside lactate levels were not predictive of ISS ≥9 or the need for admission.

Level of Evidence:

III (diagnostic test).


Bedside testing; lactate; point of care; trauma

Supplemental Content

Full text links

Icon for Medknow Publications and Media Pvt Ltd Icon for PubMed Central
Loading ...
Support Center