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Prevalence and clinical significance of point of care elevated lactate at emergency admission in older patients: a prospective study

OBJECTIVE: Patients who are over 65 years old represent up to 24% of emergency department (ED) admissions. They are at increased risk of under-triage due to impaired physiological responses. The primary objective of this study was to assess the prevalence of elevated lactate by point of care testing...

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Autores principales: Gosselin, Mélanie, Mabire, Cédric, Pasquier, Mathieu, Carron, Pierre-Nicolas, Hugli, Olivier, Ageron, Françcois-Xavier, Dami, Fabrice
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9178320/
https://www.ncbi.nlm.nih.gov/pubmed/35678940
http://dx.doi.org/10.1007/s11739-022-03005-w
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author Gosselin, Mélanie
Mabire, Cédric
Pasquier, Mathieu
Carron, Pierre-Nicolas
Hugli, Olivier
Ageron, Françcois-Xavier
Dami, Fabrice
author_facet Gosselin, Mélanie
Mabire, Cédric
Pasquier, Mathieu
Carron, Pierre-Nicolas
Hugli, Olivier
Ageron, Françcois-Xavier
Dami, Fabrice
author_sort Gosselin, Mélanie
collection PubMed
description OBJECTIVE: Patients who are over 65 years old represent up to 24% of emergency department (ED) admissions. They are at increased risk of under-triage due to impaired physiological responses. The primary objective of this study was to assess the prevalence of elevated lactate by point of care testing (POCT) in this population. The secondary objective was to assess the additional value of lactate level in predicting an early poor outcome, as compared to and combined with common clinical scores and triage scales. METHODS: This monocentric prospective study recruited ED patients who were over 65 years old between July 19th 2019 and June 17th 2020. Patients consulting for seizures or needing immediate assessment were excluded. POCT lactates were considered elevated if ≥ 2.5 mmol/L. A poor outcome was defined based on certain complications or therapeutic decisions. RESULTS: In total, 602 patients were included; 163 (27.1%) had elevated lactate and 44 (7.3%) had a poor outcome. There was no association between poor outcome and lactate level. Modified Early Warning Score (MEWS) was significantly associated with poor outcome, alongside National Early Warning Score (NEWS). Logistic regression also associated lactate level combined with MEWS and poor outcome. CONCLUSION: The prevalence of elevated lactate was 27.1%. Lactate level alone or combined with different triage scales or clinical scores such as MEWS, NEWS and qSOFA was not associated with prediction of a poor outcome. MEWS alone performed best in predicting poor outcome. The usefulness of POCT lactate measurement at triage is questionable in the population of 65 and above. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11739-022-03005-w.
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spelling pubmed-91783202022-06-09 Prevalence and clinical significance of point of care elevated lactate at emergency admission in older patients: a prospective study Gosselin, Mélanie Mabire, Cédric Pasquier, Mathieu Carron, Pierre-Nicolas Hugli, Olivier Ageron, Françcois-Xavier Dami, Fabrice Intern Emerg Med EM - Original OBJECTIVE: Patients who are over 65 years old represent up to 24% of emergency department (ED) admissions. They are at increased risk of under-triage due to impaired physiological responses. The primary objective of this study was to assess the prevalence of elevated lactate by point of care testing (POCT) in this population. The secondary objective was to assess the additional value of lactate level in predicting an early poor outcome, as compared to and combined with common clinical scores and triage scales. METHODS: This monocentric prospective study recruited ED patients who were over 65 years old between July 19th 2019 and June 17th 2020. Patients consulting for seizures or needing immediate assessment were excluded. POCT lactates were considered elevated if ≥ 2.5 mmol/L. A poor outcome was defined based on certain complications or therapeutic decisions. RESULTS: In total, 602 patients were included; 163 (27.1%) had elevated lactate and 44 (7.3%) had a poor outcome. There was no association between poor outcome and lactate level. Modified Early Warning Score (MEWS) was significantly associated with poor outcome, alongside National Early Warning Score (NEWS). Logistic regression also associated lactate level combined with MEWS and poor outcome. CONCLUSION: The prevalence of elevated lactate was 27.1%. Lactate level alone or combined with different triage scales or clinical scores such as MEWS, NEWS and qSOFA was not associated with prediction of a poor outcome. MEWS alone performed best in predicting poor outcome. The usefulness of POCT lactate measurement at triage is questionable in the population of 65 and above. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11739-022-03005-w. Springer International Publishing 2022-06-09 2022 /pmc/articles/PMC9178320/ /pubmed/35678940 http://dx.doi.org/10.1007/s11739-022-03005-w Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle EM - Original
Gosselin, Mélanie
Mabire, Cédric
Pasquier, Mathieu
Carron, Pierre-Nicolas
Hugli, Olivier
Ageron, Françcois-Xavier
Dami, Fabrice
Prevalence and clinical significance of point of care elevated lactate at emergency admission in older patients: a prospective study
title Prevalence and clinical significance of point of care elevated lactate at emergency admission in older patients: a prospective study
title_full Prevalence and clinical significance of point of care elevated lactate at emergency admission in older patients: a prospective study
title_fullStr Prevalence and clinical significance of point of care elevated lactate at emergency admission in older patients: a prospective study
title_full_unstemmed Prevalence and clinical significance of point of care elevated lactate at emergency admission in older patients: a prospective study
title_short Prevalence and clinical significance of point of care elevated lactate at emergency admission in older patients: a prospective study
title_sort prevalence and clinical significance of point of care elevated lactate at emergency admission in older patients: a prospective study
topic EM - Original
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9178320/
https://www.ncbi.nlm.nih.gov/pubmed/35678940
http://dx.doi.org/10.1007/s11739-022-03005-w
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