Francisco Martín-Rodríguez1, Raúl López-Izquierdo2, Miguel A Castro Villamor3, Iratxe Moro Mangas4, Pablo Del Brío Ibáñez5, Juan F Delgado Benito6, José L Martín Conty7, Jesús Álvarez Manzanares8, Agustín Mayo-Iscar9, Carlos Del Pozo Vegas4. 1. Advanced Clinical Simulation Center, Department of Medicine, Dermatology and Toxicology, Faculty of Medicine, University of Valladolid, Avda. Ramón y Cajal, 7, 47005 Valladolid, Spain; Prehospital Emergency Medical Services, Advanced Medical Life Support, SACYL, Castilla y León, Spain. Electronic address: fmartin@saludcastillayleon.es. 2. Emergency Department, Rio Hortega University Hospital of Valladolid, SACYL, Spain. Electronic address: rlopeziz@saludcastillayleon.es. 3. Advanced Clinical Simulation Center, Department of Medicine, Dermatology and Toxicology, Faculty of Medicine, University of Valladolid, Avda. Ramón y Cajal, 7, 47005 Valladolid, Spain. 4. Emergency Department, Valladolid University Clinic, SACYL, Spain. 5. Emergency Department, Rio Hortega University Hospital of Valladolid, SACYL, Spain. 6. Prehospital Emergency Medical Services, Advanced Medical Life Support, SACYL, Castilla y León, Spain. 7. Faculty of Occupational Therapy, Speech Therapy and Nursing, University of Castilla la Mancha, Talavera de la Reina, Toledo, Spain. 8. Emergency Department, Hospital Santa Bárbara, Soria, SACYL, Spain. 9. Department of Statistics and Operative Research, Faculty of Medicine, University of Valladolid, Spain.
Abstract
BACKGROUND: Prehospital Emergency Medical Services must attend to patients with complex physiopathological situations with little data and in the shortest possible time. The objective of this work was to study lactic acid values and their usefulness in the prehospital setting to help in clinical decision-making. STUDY DESIGN: We conducted a longitudinal prospective, observational study on patients over 18 years of age who, after being evaluated by the Advanced Life Support Unit, were taken to the hospital between April and June 2018. We analyzed demographic variables, prehospital lactic acid values and early mortality (<30 days). The area under the curve of the receiver operating characteristic was calculated for the prehospital value of lactic acid. RESULTS: A total of 279 patients were included in our study. The median age was 68 years (interquartile range: 54-80 years). Overall 30-day mortality was 9% (25 patients). The area under the curve for lactic acid to predict overall mortality at 30 days of care was 0.82 (95% CI: 0.76-0.89). The lactate value with the best sensitivity and specificity overall was 4.25 mmol/L with a sensitivity of 84% (95% CI: 65.3-93.6) and specificity of 70% (95% CI: 65.0-76.1). CONCLUSIONS: The level of lactic acid can be a complementary tool in the field of prehospital emergencies that will guide us early in the detection of critical patients.
BACKGROUND: Prehospital Emergency Medical Services must attend to patients with complex physiopathological situations with little data and in the shortest possible time. The objective of this work was to study lactic acid values and their usefulness in the prehospital setting to help in clinical decision-making. STUDY DESIGN: We conducted a longitudinal prospective, observational study on patients over 18 years of age who, after being evaluated by the Advanced Life Support Unit, were taken to the hospital between April and June 2018. We analyzed demographic variables, prehospital lactic acid values and early mortality (<30 days). The area under the curve of the receiver operating characteristic was calculated for the prehospital value of lactic acid. RESULTS: A total of 279 patients were included in our study. The median age was 68 years (interquartile range: 54-80 years). Overall 30-day mortality was 9% (25 patients). The area under the curve for lactic acid to predict overall mortality at 30 days of care was 0.82 (95% CI: 0.76-0.89). The lactate value with the best sensitivity and specificity overall was 4.25 mmol/L with a sensitivity of 84% (95% CI: 65.3-93.6) and specificity of 70% (95% CI: 65.0-76.1). CONCLUSIONS: The level of lactic acid can be a complementary tool in the field of prehospital emergencies that will guide us early in the detection of critical patients.
Authors: Francisco Martín-Rodríguez; Raúl López-Izquierdo; Juan F Delgado Benito; Ancor Sanz-García; Carlos Del Pozo Vegas; Miguel Ángel Castro Villamor; José Luis Martín-Conty; Guillermo J Ortega Journal: J Clin Med Date: 2020-04-18 Impact factor: 4.241