Development of a prehospital lactic acidosis score for early-mortality. A prospective, multicenter, ambulance-based, cohort study - 21/02/23
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Abstract |
Background |
Lactic acidosis is a clinical status related to clinical worsening. Actually, higher levels of lactate is a well-established trigger of emergency situations. The aim of this work is to build-up a prehospital early warning score to predict 2-day mortality and intensive care unit (ICU) admission, constructed with other components of the lactic acidosis besides the lactate.
Methods |
Prospective, multicenter, observational, derivation-validation cohort study of adults evacuated by ambulance and admitted to emergency department with acute diseases, between January 1st, 2020 and December 31st, 2021. Including six advanced life support, thirty-eight basic life support units, referring to four hospitals (Spain). The primary and secondary outcome of the study were 2-day all-cause mortality and ICU-admission. The prehospital lactic acidosis (PLA) score was derived from the analysis of prehospital blood parameters associated with the outcome using a logistic regression. The calibration, clinical utility, and discrimination of PLA were determined and compared to the performance of each component of the score alone.
Results |
A total of 3334 patients were enrolled. The final PLA score included: lactate, pCO2, and pH. For 2-day mortality, the PLA showed an AUC of 0.941 (95%CI: 0.914–0.967), a better performance in calibration, and a higher net benefit as compared to the other score components alone. For the ICU admission, the PLA only showed a better performance for AUC: 0.75 (95%CI: 0.706–0.794).
Conclusions |
Our results showed that PLA predicts 2-day mortality better than other lactic acidosis components alone. Including PLA score in prehospital setting could improve emergency services decision-making.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Prehospital lactic acidosis (PLA) score identify risk of 2 day mortality. |
• | A total of 3334 patients were considered in a derivation - validation cohort study. |
• | PLA presented an AUC of 0.941(95% CI:0.914–0.967) for the prediction of mortality. |
• | PLA improves lactate's results. |
Keywords : Clinical decision-making, Mortality, Lactate, Pre-hospital care, Acidosis
Plan
Vol 65
P. 16-23 - mars 2023 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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