The relation of the lactate, base excess and Injury Severity Scores (ISS) with mortality in trauma
Ahmet Baydın1, Türker Yardan1, Hakan Güven2, Adem Dervişoğlu3, Yavuz Otal1, Arif Onur Eden1, Aydın Deniz Karataş1
1Ondokuz Mayıs Üniversitesi, Tıp Fakültesi, Acil Tıp Anabilim Dalı, Samsun
2Okmeydanı Eğitim Ve Araştırma Hastanesi, İstanbul
3Medikal Park Hastanesi, İstanbul
Objectives: The aim of this study was to evaluate the effect of clinical scores reflecting injury severity and laboratory parameters for tissue oxygenation on the mortality of the patients with trauma.
Materials and Methods: Injury severity scoring (ISS) was estimated in the cases who admitted to the emergency department because of trauma without a previous intervention. Patients were classified as mild (ISS 5-10), moderate (ISS 11-20), and severe (ISS>20) depends on the injury severity scoring. Serum lactate levels was determined from venous blood samples. Base excess analysis were performed from the initial arterial blood gases. All cases were followed during the hospital care and results (death or discharge) were recorded.
Results: According to ISS, 17 (21%) of 79 patients had mild trauma, 30 (38%) were moderate, and 32 (41%) were severe. 24% of study patients died. 50% of the patients in the severe trauma group died and these patients also composed 79% of all deaths between three groups. Although the lactate and base excess levels were 30.63±2.8 mg/dl and -1.51±0.42 mmol/L, respectively in the survival group; they were 59.47±12.25 mg/dl and -3.60±1.12 mmol/L for lactate and base excess in the mortality group respectively. The base excess and lactate levels were as follows in the study patients according to their ISS score from mild to severe 0.73±0.62 mmol/L, -1.03±0.57 mmol/L, -3.7±0.80 mmol/L and 29.3±2.5 mg/dl, 32.0±8.1 mg/dl, 49.4±8.3 mg/dl, respectively. There was statistically significant difference both for lactate and base excess levels between three groups (p≤0.05), and these differences origined from severe trauma group both for lactate and base excess (p≤0.034).
Conclusion: Increased lactate and base excess concentrations are related with mortality in patients with trauma. Lactate and base excess should be used in the management of trauma patients.