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Triage vital signs do not correlate with serum lactate or base deficit, and are less predictive of operative intervention in penetrating trauma patients: a prospective cohort study
  1. Nicholas Caputo1,
  2. Robert Fraser1,
  3. Andrew Paliga1,
  4. Marc Kanter1,
  5. Karlene Hosford1,
  6. Robert Madlinger2
  1. 1Department of Emergency Medicine, Lincoln Medical and Mental Health Center, Bronx, New York, USA
  2. 2Department of Surgery, Division of Trauma Surgery, Lincoln Medical and Mental Health Center, Bronx, New York, USA
  1. Correspondence to Dr Nicholas Caputo, Department of Emergency Medicine, Lincoln Medical and Mental Health Center, 234 east 149th Street, Bronx, NY 10451, USA; ncaputo.md{at}gmail.com

Abstract

Background Triage vital signs are often used to help determine a trauma patient's haemodynamic status. Recent studies have demonstrated that these may not be very specific in determining major injury. The purpose of this study was to determine if there is any correlation between triage vital signs, base deficit (BD) and lactate, and to determine the odds of operative intervention in penetrating trauma patients.

Methods A prospective observational cohort study was undertaken. Baseline vital signs, BD and lactate were recorded in all patients for whom the trauma team was activated. Pearson correlation and coefficient (ρ) were calculated. ORs were calculated.

Results 75 patients were enrolled. Pearson correlations and coefficients calculated for lactate to systolic blood pressure were: −0.052 (ρ=0.0011, 95% CI −0.225 to 0.228); lactate and HR: 0.23 (ρ=0.0166, 95% CI −0.211 to 0.242); lactate and RR: 0.23 (ρ=0.054, 95% CI −0.174 to 0.277). BD to systolic blood pressure were: 0.003 (ρ=0.00001, 95% CI −0.229 to 0.224); BD and HR: −0.19 (ρ=0.038, 95% CI −0.399 to 0.038); BD and RR: −0.019 (ρ=0.0004, 95% CI −0.244 to 0.208). Odds of operative intervention were greater in patients with abnormally high lactate, OR 4.17 (95% CI 1.57 to 11), but not for BD, OR 2.53 (95% CI 0.99 to 6.45), or any of the vital signs.

Conclusions Triage vital signs have no correlation to lactate or BD levels in penetrating trauma patients. Odds of operative intervention are greater in patients with abnormally high serum lactate levels, but not in those with abnormal triage vital signs or BD.

  • Lactate
  • triage
  • base deficit
  • vital signs
  • trauma
  • research
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Footnotes

  • Competing interests None.

  • Patient consent This study analysed data already collected per the policy of the departments of trauma surgery and emergency medicine for the management of trauma patients. All trauma patients get triage vital signs and point-of-care lactate.

  • Ethics approval Ethics approval was provided by the Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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