젖산 현장검사: 영아 설사 환자의 응급의료자원 활용과 예후 예측 지표

• Published in: Taehan Soa Ŭnggup Ŭhakhoe chi pp. 81 - 86
• Main Authors: 이재승, 문형준, 김도의, 정동길, 김현준, 이현정, 이동욱
• Format: Journal Article
• Language: Korean
• Published: 대한소아응급의학회 01.12.2021
• Subjects: 소아과학
• ISSN: 2383-4897; 2508-5506

Purpose: Fluid therapy for diarrhea-induced dehydration inadvertently increases emergency department length of stay (EDLOS). To prevent this delay, we investigated the usefulness of triage using point-of-care (POC) lactate in infants with diarrhea. Methods: This study was performed on infants with diarrhea who visited the emergency department from January 2019 through December 2020. According to the POC lactate concentration and the Korean Triage and Acuity Scale (KTAS) level, the infants were separately divided into the low (< 2 mmol/L), moderate (2-3.9), and high (≥ 4) lactate groups and the mild (KTAS 4-5) and severe (1-3) groups, respectively. Using these 2 group designations, we compared variables regarding the emergency medicine resource use and outcomes. To predict the prolonged EDLOS (≥ median value) we performed logistic regression and receiver operating characteristic analyses. Results: A total of 540 infants were included. The median of EDLOS was 169 minutes (interquartile range, 103-220). Fluid therapy was more frequently performed in the high lactate group than in the low-moderate lactate groups (85.0% vs. 60.4%- 73.6%; P = 0.025). The high lactate and severe groups respectively showed higher rates of hospitalization (40.0% vs. 3.8%- 7.6% [P < 0.001] and 10.9% vs. 1.4% [P = 0.015]), and longer median EDLOS (259 minutes vs. 147-178 [P < 0.001] and 185 vs. 131 [P = 0.001]) compared to the low-moderate lactate and mild groups. Compared to the KTAS, lactate is more strongly associated with the prolonged EDLOS (lactate, adjusted odds ratio, 4.80 [95% confidence interval, 1.87-15.34] vs. KTAS, 3.52 [1.90-6.54]). The areas under curve for lactate and for the KTAS were 0.66 (0.60-0.73) and 0.62 (0.55-0.69), respectively (P = 0.058). Conclusion: In infants with diarrhea, POC lactate can be a predictor of emergency medicine resource use and outcomes KCI Citation Count: 0