Serum Lactate a Predictor of Morbidity & Mortality? - Patient Care - @

Serum Lactate a Predictor of Morbidity & Mortality?

Study analyzes outcomes in trauma patients



Keith Wesley, MD, FACEP | Marshall J. Washick, BAS, NREMT-P | | Tuesday, August 23, 2011

Review Of: Francis G, Suffoletto B, Castillo J, et al. Prehospital serum lactate as a predictor of outcomes in trauma patients: A retrospective observational study. J Trauma. 2011;70(4):782–786.

The Science: This is an observational study of the use of serum lactate as a predictor of morbidity and mortality of trauma patients transported by an air medical EMS system to a level 1 trauma center. The study acquired lactate data (samples were from venous or capillary blood) on consecutive trauma over an 18-month period; 1,168 patients were included for analysis. The primary outcome was mortality with secondary outcomes being: emergent surgery and multiple organ dysfunction. The results showed that lactate was associated with mortality (OR 1.23), surgery (OR 1.13), and multiple organ dysfunction syndrome (OR 1.14). The investigators concluded that prehospital lactate could help identify patients who require more aggressive resuscitation efforts in the hospital setting.

Medic Marshall: Despite any downfalls this study may have, I believe it has tremendous implications for EMS. Point-of-care testing of serum lactate, in my humble opinion, is definitely poised to become a pervasive practice throughout the U.S. Furthermore, this study also helps to demonstrate the value of obtaining serum lactates in the field.

The Doc and I reviewed a previous article about EMS obtaining serum lactates in the field, but that was for sepsis. The authors of that study were able to demonstrate that lactate was very useful in determining if patients were in septic shock. Is anyone starting to see a trend here? Serum lactate is an indicator of distributive shock. And it can be identified before it’s too late.

So why aren’t more systems implementing this? It’s as simple as obtaining a blood glucose reading, albeit serum lactates take 60 seconds versus glucometers that take less than 30 seconds. I believe EMS providers and medical directors need to start pushing their agencies to look at the obvious benefits of this. I hope that within the next three to five years, obtaining prehospital serum lactate becomes a common practice.

Doc Wesley: I agree with Marshall that point-of-care (POC) testing for serum lactate levels has the potential to change our practice and improve patient care. The challenge, however, is to interpret these studies to determine the best method of incorporating this new science into our toolbox.

Marshall alluded to this study’s shortcomings that I believe should be reviewed. Primarily, it suffers from selection bias. The prehospital patients tested were trauma patient transported from the scene and inter-facility transport by an air medical service. Therefore, all the patients had been triaged as being at high risk of significant injury and complication. In order for serum lactate POC testing to be validated as a triage tool, it needs to be studied in a ground ambulance operation to determine if it can correctly identify those patients most likely in need for care at a regional trauma center.

But more importantly, this test needs to have sufficient negative predictive value (that is when the test is negative it indicates the patient is not at risk). Unfortunately, POC lactate testing misses about 8–10% of patients later found to be at risk. Is there a role for this test in trauma? I don’t know yet. It appears to have promise, but it’s not ready for primetime until additional studies are performed.

Connect: Have a thought or feedback about this? Add your comment now
Related Topics: Patient Care, Trauma, Street Science, serum lactate, Marshall Washick, Keith Wesley

Author Thumb

Keith Wesley, MD, FACEP

Keith Wesley, MD, FACEP, is the Minnesota State EMS medical director and the EMS medical director for HealthEast Ambulance in St. Paul, Minn. and and can be reached at


Author Thumb

Marshall J. Washick, BAS, NREMT-Pis a paramedic and the peer-review/research coordinator for HealthEast Medical Transportation. He can be contacted at


What's Your Take? Comment Now ...

Buyer's Guide Featured Companies

Featured Careers & Jobs in EMS

Get JEMS in Your Inbox


Fire EMS Blogs

Blogger Browser

Today's Featured Posts


EMS Airway Clinic

Improving Survival from Cardiac Arrest Using ACD-CPR + ITD

Using active compression-decompression CPR with an ITD has been shown to improve 1-year survival from cardiac arrest by 33%.
More >

Multimedia Thumb

Explosion Shakes Mexico Hospital

Rescuers search ruins of children’s hospital.
More >

Multimedia Thumb

Hands On February 2015

Here’s a look at this month’s product hands on.
More >

Multimedia Thumb

Nightwatch Series Premiere Party

JEMS Editor-in-Chief A.J. Heightman attends the series premiere of A&E's new reality show, "Nightwatch."
More >

Multimedia Thumb

Braun Ambulances' EZ Door Forward

Helps to create a safer ambulance module.
Watch It >

Multimedia Thumb

Field Bridge Xpress ePCR on iPad, Android, Kindle Fire

Sneak peek of customizable run forms & more.
Watch It >

Multimedia Thumb

VividTrac offered by Vivid Medical - EMS Today 2013

VividTrac, affordable high performance video intubation device.
Watch It >

More Product Videos >