Prehospital Point-of-Care Lactate as a Predictor of Early Operative and Emergency Interventions in Trauma Patients: A Systematic Review.

Abstract

Early identification of trauma patients requiring immediate operative or emergency intervention remains a major challenge in the prehospital setting. Traditional physiological parameters, such as systolic blood pressure and shock index, may fail to detect occult hypoperfusion, particularly in patients with normal blood pressure (normotensive). Prehospital point-of-care (POC) lactate measurement, which allows rapid bedside assessment of blood lactate levels, has emerged as a potential biomarker to improve early risk stratification and guide timely surgical preparedness. Evidence from observational studies suggests that elevated prehospital lactate is consistently associated with an increased likelihood of early invasive management, including emergency surgery, interventional radiology, and resuscitative care. Lactate appears to offer superior or complementary predictive performance compared with traditional physiological measures, particularly in normotensive trauma patients, and is most strongly correlated with immediate operative intervention within six hours of injury. Despite these promising findings, a small number of studies and the absence of prospective lactate-guided interventional trials limit the current evidence. Integrating prehospital lactate measurement into trauma triage and decision-making algorithms may enhance early recognition of patients requiring urgent operative care, but further research is needed to determine whether this approach improves operative timing and clinical outcomes.