O. M. Kassar1, J. S. Young1 1University Of Virginia,Division Of Acute Care & Trauma Surgery,Charlottesville, VA, USA
Introduction: Prior studies have demonstrated that persistent lactic acidemia at 24 hours is correlated with poor clinical outcomes and longer hospital stays in adult trauma patients. This study was intended to investigate this observation in the pediatric trauma population.
Methods: This retrospective analysis included 1037 pediatric patients (0-17 years old) admitted to a level I trauma center between 1995 and 2015. Criteria for inclusion were length of stay greater than one day, initial lactate drawn, and more than one lactate drawn if initial lactate was elevated. Elevated lactate was defined as lactate greater than or equal to 2.5mmol/L. Time to lactate clearance, defined as return of lactic acid level less than 2.5mmol/L, was recorded in hours. Primary outcomes included mortality and length of stay. Statistical analyses were performed using SPSS statistical software (IBM Corp.) and Microsoft Excel (Microsoft Corp). For all statistical tests, a p value less than 0.05 was considered statistically significant.
Results: The majority of pediatric trauma admissions resulted from MVC (68.6%) followed by falls (14.9%). Mean injury severity score was 12 and mean length of stay was six days among all patients. Of 1037 patients, only 17 died. Patients were divided into five cohorts based on time to lactate clearance. Increased mortality correlated with longer time to lactate clearance and trended toward significance. Statistically significant differences in both mortality (0.62% vs 14.5%) and length of stay (five vs nine days) were observed between patients with and without lactate clearance within 12 hours, respectively.
Conclusion: Contrary to observations in adult trauma populations, pediatric patients experience significantly increased mortality after only 12 hours of persistent lactic acidemia. Lactate clearance before 12 hours in pediatric trauma patients is associated with both improved outcomes and shorter length of stay.
