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Elevated serum lactate levels and age are associated with an increased risk for severe injury in trauma team activation due to trauma mechanism

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Abstract

Background

The identification of risk factors for severe injury is crucial in trauma triage and trauma team activation (TTA) depends on a sufficient triage. The aim of this study was to determine whether or not elevated serum lactate levels and age are risk factors for severe injury in TTA due to trauma mechanism.

Methods

We conducted a retrospective cohort study in a single level one trauma center between September 2019 and May 2021 and analysed every TTA due to trauma mechanism. Primary endpoint of interest was the association of serum lactate as well as age with injury severity assessed by the injury severity score (ISS).

Results

During the study period, we included 250 patients. Mean age was 43.3 years (Min.: 11, Max.: 90, SD: 18.7) and the initial lactate level was 1.7 mmol/L (SD: 0.95) with a mean ISS of 8.4 (SD: 8.99). The adjusted odds ratio (OR) for age > 65 being associated with an ISS > 16 is 9.7 (p < 0.001; 95% CI 4.01–25.58) and for lactate > 2.2 mmol/L being associated with an ISS > 16 is 6.29 (p < 0.001; 95% CI 2.93–13.48). A lactate level of > 4 mmol/L results in a 36-fold higher risk of severe injury with an ISS > 16 (OR 36.06; 95% CI 4–324.29).

Conclusion

This study identifies age (> 65) and lactate (> 2.2 mmol/L) as independent risk factors for severe injury in a TTA due to trauma mechanism. Existing triage protocols might benefit from congruous amendments.

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Availability of data and materials

The dataset generated and analyzed during the current study is not publicly accessible but is available from the corresponding author on reasonable request.

Code availability

Not applicable.

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Authors and Affiliations

  1. Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany

    Paul Hagebusch, Philipp Faul, Alexander Klug, Yves Gramlich, Reinhard Hoffmann & Uwe Schweigkofler

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  1. Paul Hagebusch
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  2. Philipp Faul
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  3. Alexander Klug
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  4. Yves Gramlich
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  6. Uwe Schweigkofler
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Contributions

PH (BG Unfallklinik Frankfurt am Main—Department of Trauma and Orthopedic Surgery) is the corresponding author. PF (BG Unfallklinik Frankfurt am Main—Department of Trauma and Orthopedic Surgery) made substantial contributions to the conception, the design of the work, the acquisition, the analysis and interpretation of data and was a major contributor in writing the manuscript. AK (BG Unfallklinik Frankfurt am Main—Department of Trauma and Orthopedic Surgery) made substantial contributions to the conception, the design of the work, the acquisition, the analysis and interpretation of data. YG (Ministry of Health—City of Frankfurt) made substantial contributions to the conception and the design of the work. RH (BG Unfallklinik Frankfurt am Main—Department of Trauma and Orthopedic Surgery) made substantial contributions to the conception and design of the work and substantively revised it. US (BG Unfallklinik Frankfurt am Main—Department of Trauma and Orthopedic Surgery) made substantial contributions to the conception, the design of the work, the acquisition, the analysis and interpretation of data and substantively revised it. All authors read and approved the final manuscript.

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Correspondence to Paul Hagebusch.

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The authors listed below declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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The protocol of investigation was checked and approved by the Regional Ethics Committee (2020-1746-evBO).

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Hagebusch, P., Faul, P., Klug, A. et al. Elevated serum lactate levels and age are associated with an increased risk for severe injury in trauma team activation due to trauma mechanism. Eur J Trauma Emerg Surg 48, 2717–2723 (2022). https://doi.org/10.1007/s00068-021-01811-z

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