Comparison of the Prognostic Significance of Initial Blood Lactate and Base Deficit in Trauma Patients

Abstract

Trauma related morbidities and mortalities represent a great burden on both health and economic aspects. Most trauma deaths occur within 48hours of injury, and half of them are related to hemorrhage. Early prediction of hemorrhage or impending hemorrhage is associated with better outcomes with significant decrease in morbidity and mortality. Initial serum lactate and base deficit are two markers for changes associated with hemorrhage. Objective: To determine the prognostic significance of initial blood lactate and base deficit in trauma patients. Patients and Methods: This study included 40 cases with polytrauma who were admitted into ICU of Ain Shams University Hospital, Egypt for six months duration starting from October 2019 to March 2020. All patients were subjected to the initial resuscitation that conducted concurrently with primary assessment. After initial resuscitation effort, all patients were subjected to full history taking including age, gender, mode and time of trauma, time of arrival and resuscitation. Full laboratory investigations were done and radiological investigations were done to detect any lesions in the skull and the brain tissue. The cases were followed up after admission till the endpoint either discharge of death followed by comparison of clinical and laboratory data of the cases according to survival. Results: The GCS on admission was statistically significant lower in the non-survivor group as compared with the survivor group (p=0.016). The mean ISS in the non-survivor group was 45.2 ± 15.1 that was statistically significant higher as compared with the survivors. The initial serum lactate level and base deficit in the non-survivor group was statistically significantly higher as compared with the survivor group. Conclusion: Initial blood lactate should be preferred to base deficit as a biologic variable in scoring systems built to assess the initial severity of trauma patients