Kelli Ishihara, MD, C.t. Grayson, MD, MPH, Carly Richards, MD, MPH, Michael Lustik, MS, Christopher Yheulon, MD. Tripler Army Medical Center
Objectives: Serum lactate is frequently tested in the Emergency Department (ED) setting to diagnose visceral ischemia and as a marker of end-organ perfusion. In the setting of abdominal pain, it is useful in the diagnosis of bowel ischemia or necrosis. It is highly nonspecific and levels can be affected by both kidney and liver function. In this retrospective study, we aim to demonstrate that serum lactate is over-utilized in the ED setting and predicts resource utilization but not the need for surgical intervention.
Methods: Emergency Department records with a chief complaint of “abdominal pain” were reviewed for the preceding 12 months. We excluded pregnant patients, those less than 18, and patients for whom a blood count and chemistry were not obtained. Vital signs, lab values, resource utilization, and outcome of the visit (admission, ICU admission, general surgical consult, surgery and length of stay) were obtained. Logistic regression models were developed to correct for confounding associations.
Results: 753 patients were included, with an average age of 38 (median 32). Men comprised 44% of the sample. Serum lactate was drawn in 118 patients (15.6%) and was elevated in 19 patients (16.1% of those drawn). Serum lactate was more likely to be drawn in older patients (p<.001), males (p<.001), and in patients with a history of hypertension, COPD, diabetes, CHF, CAD, or kidney disease (p<.001 for all). However, association with comorbidities was not significant after adjusting for age. Although lactate utilization was higher in patients with hypotension (p=.016) and fever (p<.001) at presentation, 29% of all patients who had lactate drawn had 0/4 Systemic Inflammatory Response System (SIRS) criteria. Of those patients, only one had an elevated lactate (3.4%). Utilization of CT imaging was also associated with lactate utilization (p<.001). Patients in whom lactate was drawn were more likely to have a general surgery consult (51% vs. 34%, p<.001) and to be admitted to the hospital (p<.001). Patients with lactate drawn were less likely to require surgery during admission, albeit statistically insignificant (p=.132).
Conclusion: Utilization of serum lactate in the ED predicted utilization of other resources (imaging, surgical consultation and admission) but was not predictive of the need for surgical intervention. The use of serum lactate in the workup of abdominal pain patients should be targeted at patients who have signs of sepsis and based on the index of suspicion for specific disease processes such as mesenteric ischemia.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 81029
Program Number: MSSP06
Presentation Session: Military Poster (Non CME)
Presentation Type: MSSPoster