Boston Medical Center trauma surgeon and Assistant Professor of Surgery at Boston University School of Medicine, Tracey Dechert, MD, recently published, “Lactate in trauma: a poor predictor of mortality in the setting of alcohol ingestion”, in The American Surgeon.
Resuscitation end point markers such as lactate and base deficit (BD) are used in trauma to identify and treat a state of compensated shock. Lactate and BD levels are also elevated by alcohol. In blunt trauma patients with positive blood alcohol levels, lactate may be a poor indicator of injury. Retrospective data were collected on 1083 blunt trauma patients with positive blood alcohol levels admitted a Level I trauma center between 2003 and 2006. Patients were stratified by Injury Severity Score, age, gender, and Glasgow Coma Score. Logistic regression analyses were used to assess lactate and BD as independent risk factors for mortality. Seventy-four per cent of patients had an abnormal lactate level compared with 28 per cent with abnormal BD levels. In patients with mild injury, lactate levels were abnormal in more than 70 per cent of patients compared with less than 20 per cent of patients with abnormal BD levels. Linear regression showed lactate is not a significant predictor of mortality. Regardless of Injury Severity Score, lactate appeared to be more often abnormal than BD in the setting of alcohol ingestion. Additionally, because BD, and not lactate, was shown to be an independent predictor of mortality, lactate may not be a reliable marker of end point resuscitation in this patient population.
Am Surg. 2011 Dec;77(12):1576-9.Lactate in trauma: a poor predictor of mortality in the setting of alcohol ingestion. Herbert HK, Dechert TA, Wolfe L, Aboutanos MB, Malhotra AK, Ivatury RR, Duane TM. Source Department of General Surgery, Virginia Commonwealth University, Medical College of Virginia, Richmond, VA, USA.
Tracey Dechert – Trauma Surgeon: Video for Eastern Association for the Surgery of Trauma (EAST)