Invited commentary: "Identifying traumatic significant haemorrhage is challenging for patient with low and intermediate risk, not when bleeding is obvious"

• Published in: Scandinavian journal of trauma, resuscitation and emergency medicine Vol. 31; no. 1; p. 98
• Main Authors: Griggs, Joanne E, Lyon, Richard M, Sherriff, Martyn, Barrett, Jack W, Wareham, Gary, Avest, Ewoud Ter
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 12.12.2023; Springer Nature B.V; BioMed Central; BMC
• Subjects: Biological products; Hemorrhage; Lactates
• ISSN: 1757-7241; 1757-7241
• DOI: 10.1186/s13049-023-01162-1

The cut-off value of a P-LACT < 2.5 mmol/l used in our population yielded a sensitivity of 80% (corresponding to a low probability of major haemorrhage as the authors rightly mention), and hence was inadequate to be used in isolation. To identify patients with a high likelihood of major haemorrhage requiring in-hospital transfusion, a P-LACT of 6.0 mmol/l was used, as at this this point the predicted probability curve (Fig. 2 in our original article) starts to flatten: using a higher cut-off would not have yielded a higher specificity, whereas a lower cut-off would have dropped specificity whilst not yielding a much higher proportion of the population meeting the cut-off criteria (n = 13, 6.7% for a lactate of 6.0 mmol/l vs. n = 17, 8.7% for a lactate of 5.5 mmol/l). [...]we acknowledge that transfusion requirement is not always a good surrogate to use for outcome, especially not when confounding by indication may be present: using lactate may result in transfusing more patients in the pre-hospital setting, which again may result in a lower threshold to continue transfusion in-hospital.