The Effect of Lactate Level on Early Mortality and Late Wound Healing in Children with Thoracoabdominal Trauma with Fluid Treatment Before Hospital
1Department of Pediatric Surgery, Cumhuriyet University Medical Faculty, Sivas, Turkey
2SBU Istanbul Bağcılar Training and Research Hospital, Emergency Medicine Clinic, Istanbul, Turkey
DOI: 10.22514/sv.2020.16.0068 Vol.16,Issue 2,October 2020 pp.75-81
Published: 28 October 2020
Background: In this study, we aimed to evaluate the effect of serum lactate levels on early mortality and late wound healing in patients with childhood thoracoabdominal trauma, pre-hospital fluid replacement in patients admitted to the emergency department. Methods: This study included 479 patients under the age of 18 who applied to the emergency room for thoracoabdominal trauma between January 2014 and December 2018. Of these, 278(58%) were male, with a mean age of 8.34 years (range, 1-16 years). Demographic characteristics, fluid resuscitation, and serum lactate levels, trauma pattern, and mortality results of these patients were evaluated retrospectively. Results: 474 (98.9%) of the cases were blunt and 5 (1.1%) were penetrating trauma. 225 (47%) of the trauma cases were less than one meter falling, 162 (33.8%) were over one meter falling from the high, and 87 (18.2%) were car accidents inside and outside. Mortality was found most common in falling from height cases, which were related to prolonged hospitalization and high lactate level (p < 0.05). Wound healing times of patients undergoing pre-hospital fluid resuscitation and wound healing times of patients without pre-hospital fluid resuscitation were compared. Multivariate regression analysis, lactate level, and wound healing time were found to be predictive of the values found to be significant in the univariate regression analysis with fluid resuscitation and mortality (p < 0.05). Conclusion: Most thoracoabdominal traumas can be treated with conservative methods. Pre-hospital fluid treatment in severe trauma cases may lead to decreased lactate levels, reduced mortality, and shortened wound healing time.
Emergency, Child thoracoabdominal trauma, Fluid resuscitation, Lactate, Wound healing, Mortality
Cengiz Güney,Abuzer Coskun. The Effect of Lactate Level on Early Mortality and Late Wound Healing in Children with Thoracoabdominal Trauma with Fluid Treatment Before Hospital. Signa Vitae. 2020. 16(2);75-81.
 Holcomb JB, Wade CE, Trauma Outcomes Group, et al. Trauma Out-comes Group. Defining present blood component transfusion practices in trauma patients: papers from the Trauma Outcomes Group. J Trauma. 2011;71:315–317.
 Seamon MJ, Fisher CA, Gaughan J, et al. Prehospital procedures before emergency department thoracotomy: ‘‘Scoop and Run’’ saves lives. J Trauma Acute Care Surg. 2007;63:113-120.
 Krausz MM, Bar-Ziv M, Rabinovici R, et al. ‘‘Scoop and Run’’ or stabilize hemorrhagic shock with normal saline or small-volume hypertonic saline? J Trauma Acute Care Surg. 1992;33:6-10.
 Kauvar DS, Lefering R, Wade CE. Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma. 2006;60:3–11.
 Salomone JP, Ustin JS, McSwain NE Jr, et al. Opinions of trauma practitioners regarding prehospital interventions for critically injured patients. J Trauma. 2005;58:509–515.
 Trunkey DD. Is ALS necessary for pre-hospital trauma care? J Trauma. 1984;24:86–87.
 Bickell WH, Wall MJ, Pepe PE, et al. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med. 1994;331:1105-1109.
 Mizushima Y, Nakao S, Idoguchi K, et al. Fluid resuscitation of trauma patients: How much fluid is enough to determine the patient’s response?Am J Emerg Med. 2017;35:842-845.
 Broder G, Weil M H. Excess Lactate: An Index of Reversibility of Shock in Human Patients. Science. 1964;143:1457-1459.
 Broussard CL. Hyperbaric Oxygenation and Wound Healing. J Wound Ostomy Continence Nurs. 2003; 30:210–216.
 Boykin JV. Hyperbaric oxygen therapy: a physiological approach to selected problem wound healing. Wounds 1996;8:183-198.
 Dübendorfer C, Billeter AT, Seifert B, et al. Serial lactate and admission SOFA scores in trauma: an analysis of predictive value in 724 patients with and without traumatic brain injury. Eur J Trauma Emerg Surg. 2013;39:25–34.
 Dula DJ, Wood GC, Rejmer AR, et al. Use of prehospital fluids in hypotensive blunt trauma patients. Prehosp Emerg Care. 2002;6:417-420.
 Duke MD, Guidry C, Guice J, et al. Restrictive fluid resuscitation in combination with damage control resuscitation: time for adaptation. J Trauma Acute Care Surg. 2012;73:674–678.
 Aslar AK, Kuzu MA, Elhan AH, et al. Admission lactate level, and the APACHE II score are the most useful predictors of prognosis following torso trauma. Injury. 2004;35:746–752.
 Sammour T, Kahokehr A, Caldwell S, et al. Venous glucose and arterial
lactate as biochemical predictors of mortality in clinically severely injured trauma patients a comparison with ISS and TRISS. Injury. 2009;40:104–108.
 Meregalli A, Oliveira RP, Friedman G. Occult hypoperfusion is associated with increased mortality in hemodynamically stable, high-risk, surgical patients. Crit Care. 2004;8:60–65.
 Uzoigwe CE, Venkatesan M, Smith R, et al. Serum lactate is a prognostic indicator in patients with hip fracture. Hip Int. 2012;22:580–584.
 Lewis CT, Naumann DN, Crombie N, et al. Prehospital point-of-care lactate following trauma: A systematic review. J Trauma Acute Care Surg. 2016;81:748-755.
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