Abnormal arterial blood gas and serum lactate levels do not alter disposition in adult blunt trauma patients after early computed tomography

Abstract

Introduction: Arterial blood gas and serum lactate (ABG / SL) values have been shown to be markers for occult shock and poor outcome following blunt trauma. However, the utility of ABG / SL in blunt trauma patients who also receive computed tomographies (CT) of the chest, abdomen, and pelvis (CT C&A) remains unknown.

Methods: A chart review was performed of all adult blunt trauma patients who received both CT C&A and ABG / SL upon presentation to our emergency department (ED) between January 1, 2007 and December 31, 2007. These patients (n=360) were identified from our institutional trauma registry database. Patients were divided into subgroups based upon whether they had a positive or negative ED evaluation for traumatic injury requiring hospitalization or immediate operative management. The expected course for patients with negative ED evaluations regardless of ABG / SL was discharge home. The primary outcome measure was the proportion of patients with a negative ED evaluation and an abnormal ABG or SL that were admitted to the hospital.

Results: 2.9% of patients with a negative ED evaluation and abnormal ABG or SL were admitted. Of these, none were found to have any post-traumatic sequalae.

Conclusion: We found that abnormal ABG / SL results do not change management or discharge disposition in patients without clinical or radiographic evidence of traumatic injury on CT C&A. Among patients who receive CT C&A, the routine measurement of arterial blood gas and lactate may be an unnecessary source of additional cost, patient discomfort, and delay in care.

Figure 1.

Trauma Criteria. BP, blood pressure; GSW, gun shot wound; ED, emergency department; TBSA, total body surface area

Figure 2.

Study results.