The following is a summary of “Development of a prehospital lactic acidosis score for early-mortality. A prospective, multicenter, ambulance-based, cohort study,” published in the March 2023 issue of Emergency Medicine by Rodríguez, et al.

A clinical condition associated with clinical deterioration is lactic acidosis. Higher lactate levels are a recognized emergency situation trigger. For a study, researchers sought to develop a prehospital early warning score that used additional indicators of lactic acidosis besides lactate to predict 2-day mortality and intensive care unit (ICU) admission.

Adults with acute illnesses who were transported by ambulance and treated in emergency departments between January 1 and December 31, 2021, were the subjects of a prospective, multicenter, observational, derivation-validation cohort study. Included were 4 hospitals, 38 basic life support units, and 6 advanced life support units (Spain). The study’s primary and secondary outcomes were ICU admission and 2-day all-cause death. Prehospital blood markers related to the outcome were analyzed using logistic regression to create the prehospital lactic acidosis (PLA) score. The performance of each component of the score was evaluated separately to determine the calibration, clinical utility, and discrimination of PLA.

3,334 patients in all were signed up. Lactate, pCO2, and pH made up the final PLA score. The PLA performed better in calibration and had a higher net benefit when compared to the other score components alone for 2-day mortality, with an AUC of 0.941 (95%CI: 0.914-0.967). The only aspect of the ICU admission where the PLA performed better was the AUC, which was 0.75 (95%CI: 0.706-0.794).

The findings indicated that PLA was a better predictor of 2-day mortality than lactic acidosis’ other individual components. Decision-making by emergency services could be improved by including PLA scores in the prehospital environment.

Reference: sciencedirect.com/science/article/pii/S0735675722007732