Biomarkers help identify critically injured patients with only moderate risk of severe injuries in trauma team activation.

Abstract

Purpose: Accurate trauma triage ensures timely and specialized care for potentially critically injured patients. Undertriage remains a concern, particularly for patients without obvious vital sign derangements. This study evaluates the potential of biomarkers such as lactate, base deficit (BD), and blood glucose to improve triage score accuracy in identifying patients with severe injuries (Injury Severity Score [ISS] > 15) and predicting intensive care unit (ICU) admission without a high risk of severe injury (HRSI).

Methods: This retrospective, single-center cohort study (2017-2021) included trauma patients with trauma team activation (TTA) due to mechanism of injury(MOI) and therefore only patients with moderate risk of severe injury criteria(MRSI). Exclusion criteria were any HRSI-criterion such as advanced airway management, Glasgow Coma Scale < 12, systolic blood pressure < 90 mmHg, and specific injury patterns. Biomarkers were collected upon emergency department (ED) admission. Logistic regression and receiver operating characteristic (ROC) curve analyses evaluated biomarker predictive value alone and in combination with existing triage scores.

Results: The study population included 3371 TTAs of which we were able to include 302 in our study-group. 15% had ISS > 15. These patients had significantly higher lactate (2.38 ± 1.2 vs. 1.57 ± 0.75 mmol/L, p < 0.05), BD (-0.2 ± 5.0 vs. 1.7 ± 2.7 mmol/L, p < 0.05), and blood glucose (144.8 ± 46.0 vs. 118 ± 37.9 mg/dL, p < 0.05). Augmenting triage scores with lactate improved predictive accuracy, with the highest AUC (0.774) observed for the age-lactate model. ICU admission prediction was less robust (AUC = 0.674).

Conclusion: Our findings suggest that biomarkers such as lactate could strengthen trauma triage scores, but prospective, multicenter validation is essential to confirm these preliminary results.