The efficacy of lactate point-of-care test in the emergency department for triage of pesticide poisoning patients with stable vital signs and alert mental status

Kim, Daedan; Shin, Tae Yong; Moon, Hyung Jun; Lee, Hyun Jung; Jeong, Dongkil; Kim, Hyun Joon; Lee, Dongwook

J Korean Soc Emerg Med > Volume 34(2); 2023 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2023;34(2): 115-120.

활력징후와 의식수준이 정상인 농약중독 환자를 대상으로 응급실 젖산 현장검사를 통한 환자분류 유용성

김대단, 신태용

순천향대학교 천안병원 응급의학과

The efficacy of lactate point-of-care test in the emergency department for triage of pesticide poisoning patients with stable vital signs and alert mental status

Daedan Kim, Tae Yong Shin

Department of Emergency Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea

Correspondence

Dongwook Lee ,Tel: 041-570-2119, Fax: 041-592-3806, Email: yisfm83@gmail.com,

Received: July 9, 2022; Revised: September 30, 2022 Accepted: October 12, 2022. Published online: April 30, 2023.

ABSTRACT

Objective:
Pesticide poisoning is one of the leading causes of death, and it is important to classify high-risk patients. Lactate measurement could be used to assess the triage level and decide and prioritize treatment even within the same triage group. This study investigates whether point-of-care lactate measurement helps to triage pesticide poisoning patients in the emergency department (ED).
Method:
This retrospective study was done for pesticide poisoning patients between January 2018 to December 2021. Demographic data and laboratory results were collected by reviewing medical records. Statistical analysis was performed by dividing patients into death and survival groups. Univariable and multivariable logistic regression analyses were done. Receiver operating characteristic curves were obtained for variables with significant differences, and area under the curves (AUC) were calculated and compared.
Results:
Among the 288 patients evaluated, there were 24 (8.33%) mortalities and 264 (91.67%) survivals during hospitalization. Age, the Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, pH and base excess, and lactate levels were analyzed via univariable and multivariable logistic regression tests. We found that old age and high lactate were independent factors in predicting mortality for pesticide poisoning patients. AUCs with 95% confidence interval for age and lactate were 0.784 (0.653-0.915) and 0.803 (0.674-0.932), respectively.
Conclusion:
Lactate measurement may be useful during triage of alert and consciousness patients presenting with pesticide poisoning and having stable vital signs in ED. This study has several limitations, and it is necessary to reconfirm the results through a well-designed prospective study.

Key words: Pesticides; Lactic acid; Triage