ArticleScandinavian journal of trauma, resuscitation and emergency medicine2022
Predictive clinical utility of pre-hospital point of care lactate for transfusion of blood product in patients with suspected traumatic haemorrhage: derivation of a decision-support tool.
Article in Scandinavian journal of trauma, resuscitation and emergency medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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6 citing papers in PubMed, 25 citations in OpenAlex.
- Comprehensive Evaluation of a Point-of-Care Testing Platform for Decentralized Primary Healthcare: Ensuring Analytical Quality Through Central Laboratory Oversight.Diagnostics (Basel, Switzerland) · 2025Article
- [Prehospital blood transfusion : Opportunities and challenges for the German emergency medical services].Die Anaesthesiologie · 2024Review
- Identifying trigger cues for hospital blood transfusions based on ensemble of machine learning methods.International journal of emergency medicine · 2024Article
- Identifying Trigger Cues for Hospital Blood Transfusions Based on Ensemble Learning Methods.Research square · 2024Article
- Benefits, barriers and facilitators for out-of-hospital point of care testing: a qualitative study.NIHR open research · 2024Article
- Identifying traumatic significant haemorrhage is challenging for patient with low and intermediate risk, not when bleeding is obvious.Scandinavian journal of trauma, resuscitation and emergency medicine · 2023Article
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7 authors at 5 institutions in 2 countries.
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No grant is acknowledged in the PubMed record.
Abstract
introductionPre-hospital emergency medical teams can transfuse blood products to patients with suspected major traumatic haemorrhage. Common transfusion triggers based on physiological parameters have several disadvantages and are largely unvalidated in guiding pre-hospital transfusion. The addition of pre-hospital lactate (P-LACT) may overcome these challenges. To date, the clinical utility of P-LACT to guide pre-hospital blood transfusion is unclear.
methodsA retrospective analysis of patients with suspected major traumatic haemorrhage attended by Air Ambulance Charity Kent Surrey Sussex (KSS) between 8 July 2017 and 31 December 2019. The primary endpoint was the accuracy of P-LACT to predict the requirement for any in-hospital (continued) transfusion of blood product.
resultsDuring the study period, 306 patients with suspected major traumatic haemorrhage were attended by KSS. P-LACT was obtained in 194 patients. In the cohort 103 (34%) patients were declared Code Red. A pre-hospital transfusion was commenced in 124 patients (41%) and in-hospital transfusion was continued in 100 (81%) of these patients, in 24 (19%) patients it was ceased. Predictive probabilities of various lactate cut-off points for requirement of in-hospital transfusion are documented. The highest overall proportion correctly classified patients were found for a P-LACT cut-point of 5.4 mmol/L (76.50% correctly classified). Based on the calculated predictive probabilities, optimal cut-off points were derived for both the exclusion- and inclusion of the need for in-hospital transfusion. A P-LACT < 2.5 mmol/L had a sensitivity of 80.28% and a negative likelihood ratio [LR-] of 0.37 for the prediction of in-hospital transfusion requirement, whereas a P-LACT of 6.0 mmol/L had a specificity of 99.22%, [LR-] = 0.78.
conclusionPre-hospital lactate measurements can be used to predict the need for (continued) in-hospital blood products in addition to current physiological parameters. A simple decision support tool derived in this study can help the clinician interpret pre-hospital lactate results and guide pre-hospital interventions in the major trauma patient.
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