Publications (2)2.28 Total impact
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Article: Comparison of the trauma and injury severity score and modified early warning score with rapid lactate level (the ViEWS-L score) in blunt trauma patients.
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ABSTRACT: OBJECTIVE: The aim of this study was to compare the predictive value of the VitalPAC Early Warning Score-lactate (ViEWS-L) score with that of the trauma and injury severity score (TRISS), which is a pre-existing risk scoring system used in trauma patients. METHODS: The patients were blunt trauma victims admitted consecutively to the study hospital between 1 April 2010 and 31 March 2011, who were 15 years or older and had an injury severity score of 9 or higher. The lactate level, the ViEWS and revised trauma score upon arrival at the emergency department, and the injury severity score and TRISS were evaluated. The ViEWS-L score was calculated according to the formula: ViEWS-L=ViEWS+lactate (mmol/l). The ability to predict mortality was assessed by area under the receiver operating characteristic curve (AUC) analysis and calibration analysis. RESULTS: A total of 299 patients were available for analysis, of whom 33 died (11.0%). The median ViEWS-L score was 3.7 (interquartile range:1.8-6.4) and the median TRISS was 96.8 (interquartile range: 93.4-98.6). The ViEWS-L score was better than TRISS at predicting hospital mortality (AUC, 0.838; 95% confidence interval, 0.771-0.906 vs. AUC, 0.734; 95% confidence interval, 0.635-0.833, P=0.031). Calibration of the ViEWS-L score (χ=11.13, P=0.194) was good but that of TRISS was not (χ=16.97, P=0.018). CONCLUSION: The prognostic value of the ViEWS-L score in terms of discrimination was better than that of TRISS in the blunt trauma patients admitted to the emergency department with an injury severity score of 9 or higher, and the ViEWS-L score showed good calibration.European journal of emergency medicine: official journal of the European Society for Emergency Medicine 04/2013; · 0.73 Impact Factor -
Article: Initial hyperlactatemia in the ED is associated with poor outcome in patients with ischemic stroke.
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ABSTRACT: Hyperlactatemia may be associated with poor outcome in patients with ischemic stroke because it reflects a state of tissue perfusion. This study aims to know whether initial hyperlactatemia in the emergency department (ED) is associated with poor outcome in patients with ischemic stroke. A retrospective observational study was performed in an urban tertiary hospital ED. Patients with an admission diagnosis of ischemic stroke were consecutively enrolled between April 1, 2010, and March 31, 2011. Lactate and glucose levels were obtained at the time of presentation to the ED, whereas the National Institutes of Health Stroke Scale score was assessed at the time of admission. Poor outcome was defined as a modified Rankin scale score greater than or equal to 2 at 3 months. The survival status at 3 months was also obtained. Hyperlactatemia was defined by lactate levels greater than 2 mmol/L. A total of 292 patients were enrolled. At 3 months after stroke, 183 (62.7%) were considered to have poor outcomes, whereas 16 (5.5%) had died. Seventy (24.0%) had initial hyperlactatemia. Multivariable logistic regression analysis showed that hyperlactatemia was independently associated with a higher risk of poor outcome at 3 months (adjusted odd ratio, 2.15; 95% confidence interval, 1.06-4.37; P=.035) and a trend to death at 3 months (adjusted odd ratio, 4.31; 95% confidence interval, 0.91-20.56; P=.066). Among patients with ischemic stroke, initial hyperlactatemia represents an independent risk factor for poor outcome after controlling for stroke severity, risk factors, initial glucose level, and interval from onset of stroke symptoms to ED arrival.The American journal of emergency medicine 03/2012; 30(3):449-55. · 1.54 Impact Factor
