Is lactate an effective clinical marker of outcome for children with major trauma? – A literature review

• Children attending ED in the UK with major trauma are rare – however the assessment of these children is difficult.
• Lactate as a marker of hypoperfusion has been used in adult trauma care for a number of years.
• There is evidence to show that a raised lactate is correlated to morbidity and mortality in the adult trauma victim.
• There is also evidence to show that there is a correlation between lactate clearance and outcome.
• There is very little evidence to show if this evidence is applicable in children.

IntroductionThe assessment and treatment of children with major injury is fraught with difficulty – differences in anatomy and physiology mean that children that have suffered trauma can be over or under assessed. In recent years, there has been an increase in the use of biochemical markers, such as haematocrit, to assist the clinician in determining severity of injury. This paper examines the evidence surrounding lactate as a marker in paediatric trauma.MethodA literature search was completed on Medline, CINAHL, Ovid and Science. 63 papers were initially identified – 41 papers were rejected after reading the abstracts. Of the 22 remaining papers – 6 had a paediatric focus, 16 were adult – of these 12 were rejected as not primary studies. Ten papers were fully critically reviewed – of these only one article related to paediatric patients and trauma.ResultsThe literature shows that an elevated lactate in a trauma patient is strongly correlated to severity of injury, length of stay and morbidity and mortality. However, one elevated lactate may be misleading and lactate clearance – that is the time when lactate levels return to normal, is just as important in the assessment of the severely injured. However, from this literature review it is clear that there is very little evidence for the relationship between lactate levels and trauma in children and that more studies are required.