TY - JOUR
T1 - Capillary lactate as a tool for the triage nurse among patients with SIRS at emergency department presentation: a preliminary report
AU - Manzon, Cyril
AU - Barrot, Loic
AU - Besch, Guillaume
AU - Barbot, Olivier
AU - Desmettre, Thibaut
AU - Capellier, Gilles
AU - Piton, Gael
PY - 2015
Y1 - 2015
N2 - Background: The triage nurse is involved in the early identification of the most severe patients at emergency
department (ED) presentation. However, clinical criteria alone may be insufficient to identify them correctly.
Measurement of capillary lactate concentration at ED presentation may help to discriminate these patients. The
primary objective of this study was to identify the prognostic value of capillary lactate concentration measured by
the triage nurse among patients presenting to the ED.
Methods: This was a prospective observational study, performed in the ED of a university hospital. At ED presentation,
capillary lactate measurement was performed by the triage nurse among patients presenting with a clinical criteria of
systemic inflammatory response syndrome (SIRS). Clinical variables usually used to determine severity were collected at
presentation. Twenty-eight-day mortality and MEDS score were recorded.
Results: One hundred seventy-six patients with clinical SIRS presented to the ED. Median age was 72 years, and
28-day mortality was 16 . Capillary lactate at ED presentation was significantly higher among 28-day non-survivors
than among survivors (5.7 mmol.L-1 [3.2 to 7.4] vs 2.9 mmol.L-1 [1.9 to 5.2], p = 0.003). A score based on mottling
and capillary lactate concentration >3.6 mmol.L-1 was significantly associated with 28-day mortality (area under
curve, AUC = 0.75), independently of the MEDS score (AUC = 0.79) for the prediction of 28-day mortality (AUC
global model 0.87).
Conclusions: A high capillary lactate concentration measured by the triage nurse among patients presenting to
the ED with clinical SIRS is associated with a high risk of death. A score calculated by the triage nurse, based on
mottling and capillary lactate concentration, appears to be useful for identifying the most severe patients.
Keywords: Systemic inflammatory response syndrome; Capillary lactate; Prognosis; Triage tool
AB - Background: The triage nurse is involved in the early identification of the most severe patients at emergency
department (ED) presentation. However, clinical criteria alone may be insufficient to identify them correctly.
Measurement of capillary lactate concentration at ED presentation may help to discriminate these patients. The
primary objective of this study was to identify the prognostic value of capillary lactate concentration measured by
the triage nurse among patients presenting to the ED.
Methods: This was a prospective observational study, performed in the ED of a university hospital. At ED presentation,
capillary lactate measurement was performed by the triage nurse among patients presenting with a clinical criteria of
systemic inflammatory response syndrome (SIRS). Clinical variables usually used to determine severity were collected at
presentation. Twenty-eight-day mortality and MEDS score were recorded.
Results: One hundred seventy-six patients with clinical SIRS presented to the ED. Median age was 72 years, and
28-day mortality was 16 . Capillary lactate at ED presentation was significantly higher among 28-day non-survivors
than among survivors (5.7 mmol.L-1 [3.2 to 7.4] vs 2.9 mmol.L-1 [1.9 to 5.2], p = 0.003). A score based on mottling
and capillary lactate concentration >3.6 mmol.L-1 was significantly associated with 28-day mortality (area under
curve, AUC = 0.75), independently of the MEDS score (AUC = 0.79) for the prediction of 28-day mortality (AUC
global model 0.87).
Conclusions: A high capillary lactate concentration measured by the triage nurse among patients presenting to
the ED with clinical SIRS is associated with a high risk of death. A score calculated by the triage nurse, based on
mottling and capillary lactate concentration, appears to be useful for identifying the most severe patients.
Keywords: Systemic inflammatory response syndrome; Capillary lactate; Prognosis; Triage tool
UR - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4414858/pdf/13613_2015_Article_47.pdf
U2 - 10.1186/s13613-015-0047-y
DO - 10.1186/s13613-015-0047-y
M3 - Article
VL - 5
SP - 1
EP - 7
JO - Annals of Intensive Care
JF - Annals of Intensive Care
SN - 2110-5820
IS - 1
ER -