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Lactate Predicts the Need for Massive Transfusion in Severe Blunt Trauma: an Analysis of the Glue Grant Database
*Antonios C Sideris, *George Kasotakis, *Ali Y Mejaddam, *Yuchiao Chang, *Marc A de Moya, *Peter J Fagenholz, Ronald G Tompkins, George C Velmahos
Massachusetts General Hospital, Boston, MA

The purpose of our study was to examine if emergency department (ED) blood lactate (BL) levels can predict need for massive transfusion (MT) and in-hospital mortality after severe blunt trauma.
Secondary analysis of a prospective, federally funded database
19 academic and non-academic trauma centers
1719 adult patients that sustained blunt non-brain trauma with hypotension in the field or within 1 hour of ED arrival and necessitated ≥1 packed red blood cells (PRBC) units in the first 12 hours.
Main Outcome Measures:
Massive transfusion (MT, ≥10 PRBC units in 24 hours) and in-hospital mortality.
1719 patients were included (age 44 ± 18, 67% male, median ISS 34, median GCS 6). Median ED BL was 4mmol/L. MT was required in 27% of patients, with a median of 6 PRBC units per patient. In-hospital mortality was 16%. Results of multivariable logistic regression models are seen below. The ED BL was more predictive than ED SBP for MT (area under curve (AUC) 0.70 vs. 0.59, p<0.001) and in-hospital mortality (AUC 0.70 vs. 0.57, p<0.001).
ED BL independently predicts the need for massive transfusion and in-hospital mortality in severe blunt trauma patients. Point-of-care BL devices will help health-care providers understand the severity of disease and make decisions about triggering MT protocols.

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Abstract Submission Deadline:
May 5, 2014

Housing Deadline:
August 13, 2014

Early Bird Registration Deadline:
August 11, 2014
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