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Figures
Fig. 1
Boxplots of time to lactate results administration. The black line in the middle of the box represents the median and the box contains the inter-quartile range.
Fig. 2
Boxplots of time to antibiotic ordering. The black line in the middle of the box represents the median and the box contains the inter-quartile range.
Fig. 3
Boxplots of time to antibiotic administration. The black line in the middle of the box represents the median and the box contains the inter-quartile range.
Fig. 4
Boxplots of time to intravenous (IV) fluid administration. The black line in the middle of the box represents the median and the box contains the inter-quartile range.
Fig. 5
Scatterplot of point-of-care and central lab lactates (r = 0.94).
Fig. 6
Bland Altman plot of point-of-care and central lab lactates. Mean difference between lactates is -.26 (SD .43).
Abstract
Objective
Early recognition and treatment of sepsis improves outcomes. We determined the effects of bedside point-of-care (POC) lactate measurement on test turnaround time, time to administration of IV fluids and antibiotics, mortality, and ICU admissions in adult ED patients with suspected sepsis. We hypothesized that bedside lactate POC testing would reduce time to IV fluids and antibiotics.
Methods
We compared 80 ED patients with suspected sepsis and a lactate level of 2 mmol/L or greater before and 80 similar patients after introduction of POC lactate measurements. Groups were compared with Χ2 and Mann Whitney U tests. A sample size of 80 patients in each group had 85% power to detect a 30-minute difference in time to IV fluids or antibiotics.
Results
Study groups were similar in age, gender, baseline lactate levels, sepsis severity, and Sequential Organ Failure Assessment (SOFA) scores. Introduction of POC lactate was associated with significant reductions in test turnaround time (34 [26-55] vs. 122 [82-149] minutes; P < 0.001), time to IV fluids (55 [34-83] vs. 71 [42-110] minutes; P = 0.03), mortality (6% vs. 19%; P = 0.02), and ICU admissions (33% vs. 51%, P = 0.02), but not time to IV antibiotics (89 [54-156] vs. 88 [60-177] minutes; P = 0.35).
Conclusions
Implementation of bedside POC lactate measurement in adult ED patients with suspected sepsis reduces time to test results and time to administration of IV fluids but not antibiotics. A significant reduction in mortality and ICU admissions was also demonstrated, which is likely due, at least in part, to POC testing.
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☆Source of funding: Abbott Point of Care, Princeton, NJ.
☆☆Author Contributions: AJS conceived of the study, and participated in its design and coordination and helped to draft the manuscript. HCT performed the statistical analysis of the data. All authors read and approved the final manuscript.
★Competing Interests: This research was supported by a research grant from Abbott Point of Care (Princeton, NJ). In addition to the provision of funding, Abbott was consulted during the design of the study. Study conception, data analysis, interpretation and manuscript preparation was performed independently by the study investigators. The first author (AJS) is on the Speaker’s Bureau of Abbot Point of Care.
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