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The Utility of Early Lactate Testing in Undifferentiated Pediatric Systemic Inflammatory Response Syndrome
Author(s) -
Scott Halden F.,
Donoghue Aaron J.,
Gaieski David F.,
Marchese Ronald F.,
Mistry Rakesh D.
Publication year - 2012
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.12014
Subject(s) - hyperlactatemia , medicine , systemic inflammatory response syndrome , organ dysfunction , sepsis , septic shock , confidence interval , prospective cohort study , pediatric intensive care unit , resuscitation , intensive care unit , multiple organ dysfunction syndrome , intensive care medicine , emergency medicine
Objectives Failure to recognize shock contributes to inadequate early resuscitation in many children with sepsis. Serum lactate levels are used to identify adult patients with septic shock, but physical examination diagnosis alone is recommended in pediatric sepsis. The authors sought to test the utility of lactate testing in pediatric emergency department ( ED ) patients with systemic inflammatory response syndrome ( SIRS ). The hypothesis was that early hyperlactatemia (serum lactate ≥ 4.0 mmol/L) would be associated with increased risk of organ dysfunction. Methods This was a prospective cohort study of children younger than 19 years with SIRS presenting to a pediatric ED . The primary outcome was organ dysfunction within 24 hours of triage; secondary outcomes included disposition, serious bacterial infection ( SBI ), treatments, and mortality. Study personnel measured venous lactate level on a point‐of‐care meter, with clinicians blinded to results, and patients received usual care. Results A total of 239 subjects were enrolled; 18 had hyperlactatemia. The hyperlactatemia group had a relative risk of 5.5 (95% confidence interval [ CI ] = 1.9 to 16.0) of developing 24‐hour organ dysfunction. As a test for organ dysfunction, hyperlactatemia had a positive likelihood ratio of 5.0, a sensitivity of 31% (95% CI = 13% to 58%), and specificity of 94% (95% CI = 90% to 96%). Subjects with hyperlactatemia were significantly more likely to receive intravenous ( IV ) antibiotics and fluid boluses; despite increased therapy, they were at significantly increased risk for intensive care unit ( ICU ) admission and bacterial infection. Conclusions Among undifferentiated children with SIRS , early hyperlactatemia is significantly associated with increased risk of organ dysfunction, resuscitative therapies, and critical illness. The addition of serum lactate testing to the currently recommended clinical assessment may improve early identification of pediatric sepsis requiring resuscitation.