Fukumoto Yuichi, Inoue Yoshiaki, Takeuchi Yuji, Hoshino Tetsuya, Nakamura Yuki, Ishikawa Kohei, Morikawa Miki, Suginaka Hiroshi, Sueyoshi Koichiro, Sumi Yuka, Matsuda Shigeru, Okamoto Ken, Tanaka Hiroshi
Department of Emergency and Critical Care Medicine Urayasu Hospital Juntendo University Urayasu Japan.
Acute Med Surg. 2015 Aug 17;3(2):101-106. doi: 10.1002/ams2.130. eCollection 2016 Apr.
Simple Triage and Rapid Treatment (START) is commonly used at disaster scenes. The Canadian Emergency Department Triage and Acuity Scale (CTAS) is used in urban and rural emergency departments (ED). However, triage is not always accurate or appropriate. The blood lactate level (BLL) is a major biomarker of physical status. We measured BLL using the Lactate Pro-1710 Test Meter in all patients transported to our ED and assessed their correlation with the triage level determined using START and the CTAS.
This retrospective study included 510 patients admitted to our ED between January 2011 and July 2012 whose BLL was measured. The patients were classified into triage divisions (green, yellow, red, and black) according to vital signs and chief complaints, and correlations among BLL, triage level, and prognosis were assessed in all groups.
Of the total, 62 patients had cardiopulmonary arrest (CPA), 262 had internal pathologies, and 186 had external pathologies. Significant correlations were observed between BLL and both START and CTAS triage. Also BLL was significantly higher in severe patients categorized with START and CTAS ( < 0.0001), especially in the death group when the patients were divided into two groups according to prognosis ( < 0.0001). Two patients categorized yellow with START died during the hospitalization, however BLL of these two patients were high on admission at the ED.
BLL could be used to correct the triage level, and decide the priority of treatment and transportation even within the same triage level, thereby avoiding under-triage.
简单预检与快速治疗（START）常用于灾难现场。加拿大急诊科预检与 acuity 量表（CTAS）用于城乡急诊科。然而，预检并不总是准确或恰当的。血乳酸水平（BLL）是身体状况的主要生物标志物。我们使用 Lactate Pro - 1710 血糖仪对所有转运至我院急诊科的患者测量 BLL，并评估其与使用 START 和 CTAS 确定的预检级别之间的相关性。
这项回顾性研究纳入了 2011 年 1 月至 2012 年 7 月间入住我院急诊科且测量了 BLL 的 510 例患者。根据生命体征和主要症状将患者分为预检类别（绿色、黄色、红色和黑色），并评估所有组中 BLL、预检级别和预后之间的相关性。
总计，62 例患者发生心肺骤停（CPA），262 例有内科疾病，186 例有外科疾病。观察到 BLL 与 START 和 CTAS 预检均存在显著相关性。而且，根据 START 和 CTAS 分类的重症患者的 BLL 显著更高（<0.0001），尤其是在根据预后将患者分为两组时的死亡组（<0.0001）。两名根据 START 分类为黄色的患者在住院期间死亡，然而这两名患者在急诊科入院时 BLL 较高。
BLL 可用于校正预检级别，并在同一预检级别内确定治疗和转运的优先级，从而避免预检不足。
