Prehospital point-of-care lactate following trauma
Bibliographic record
Abstract
BACKGROUND: Serum lactate serves as a surrogate marker for global tissue hypoxia following traumatic injury and has potential to guide resuscitation. Portable, handheld point-of-care monitoring devices enable lactate values to be readily available in the prehospital environment. The current review examines the utility of prehospital lactate (pLa) measurement in the management of trauma. METHODS: MEDLINE and EMBASE databases were searched using predefined criteria (pLa measurement, trauma patients) until March 10, 2016. Studies were examined for lactate measurement as an intervention, prognostic indicator, and utilization in the guidance of goal-directed therapy. The Newcastle-Ottawa Scale was used to assess risk of bias, and quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation system. Data were unsuitable for meta-analysis and are presented in narrative form. RESULTS: Of 2,415 articles of interest, seven met the inclusion criteria, all of which were observational studies, including 2,085 trauma patients. Lactate sampling techniques, timings, and thresholds were heterogeneous. No studies used pLa to guide intervention. Elevated pLa may be an independent prognostic marker of critical illness in trauma patients, particularly in blunt trauma. Prehospital lactate measurement may be more sensitive than systolic blood pressure in determining need for resuscitative care. Early lactate measurement may be particularly useful in the detection of occult hypoperfusion, with elevated pLa detectable within 30 minutes of injury. All current studies were assessed as being of "low" or "very low" quality and were at risk of bias. Considerable logistical barriers to pLa measurement exist. CONCLUSIONS: Prehospital point-of-care lactate monitoring for trauma has been variably performed. There is a paucity of evidence relating to its use. The limited data available show feasibility and potential clinical utility, and further investigation is warranted to establish whether lactate might give meaningful guidance during prehospital triage and trauma patient resuscitation. LEVEL OF EVIDENCE: Systematic review, level IV.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.061 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.004 | 0.005 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".