Blood Gas Analysis Results and Serum Lactate Levels in Patients with Psychogenic Hyperventilation and Urinary Tract Infection with Suspected Sepsis: A Retrospective Comparative Study

Abstract Background: Respiratory distress is one of the most common complaints of patients requiring out-of-hospital emergency services. Determining the precise discharge diagnosis in these circumstances can be challenging due to the wide range of suspected diagnoses. Moreover, these patients appear to have particularly high mortality, but little is currently known about the exact mortality rates associated with specific discharge diagnoses. Our study, therefore, aimed to determine how accurately correct diagnoses are made by EMS physicians in the out-of-hospital setting, identify examination findings that correlate with discharge diagnoses, investigate hospital mortality, and identify mortality-associated predictors.Methods: This retrospective observational study examined emergency medical service (EMS) encounters between December 2015 and May 2016 in the city of Aachen, Germany, in which an EMS physician was present at the scene. Adult patients were included if the EMS physician initially detected dyspnea, low oxygen saturation, or pathological auscultation findings at the scene (n = 719). By linking out-of-hospital data to hospital records, including initial blood gas analysis, a discharge diagnosis was assigned to each EMS encounter, and the outcome was analyzed. Binary logistic regressions were used to search for associations between pathological findings and discharge diagnoses, as well as predictors of hospital mortality.Results: The overall diagnostic accuracy was 69.9% (485/694). The highest diagnostic accuracies were observed in asthma (15/15 ≙ 100%), hypertensive crisis (28/33 ≙ 84.4%), and COPD exacerbation (114/138 ≙ 82.6%), and the lowest accuracies were observed in urinary tract infection (14/35 ≙ 40%), pulmonary embolism (8/18 ≙ 44.4%), and pneumonia (70/142 ≙ 49.3%). The overall hospital mortality rate was 13.8% (99/719). The highest hospital mortality rates were seen in pneumonia (44/142 ≙ 31%) and urinary tract infection (7/35 ≙ 20%). Potential risk factors for hospital mortality identified in this study were reduced vigilance, low oxygen saturation, increasing age, blood gas analysis (BGA) results associated with metabolic acidosis, and an incorrect out-of-hospital diagnosis by the EMS physician.Conclusions: Our data highlight the diagnostic uncertainties and high mortality in out-of-hospital emergency patients presenting with respiratory distress. The identified predictors could help in early detection of patients at risk in the future.

Download Full-text

The Value of Blood Gas Analysis in Lower Respiratory Tract Infection in Infancy

Archives of Disease in Childhood ◽

10.1136/adc.45.244.818 ◽

1970 ◽

Vol 45 (244) ◽

pp. 818-818

Author(s):

W. B. Doig

Keyword(s):

Tract Infection ◽

Respiratory Tract ◽

Respiratory Tract Infection ◽

Lower Respiratory Tract Infection ◽

Lower Respiratory Tract ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Blood Gas

Download Full-text

Value of Arterialized Capillary Blood Gas Analysis in Lower Respiratory Tract Infection in Childhood

Archives of Disease in Childhood ◽

10.1136/adc.46.247.243 ◽

1971 ◽

Vol 46 (247) ◽

pp. 243-246 ◽

Cited By ~ 4

Author(s):

W. B. Doig

Keyword(s):

Tract Infection ◽

Respiratory Tract ◽

Respiratory Tract Infection ◽

Lower Respiratory Tract Infection ◽

Lower Respiratory Tract ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Capillary Blood ◽

Blood Gas

Download Full-text

Can Peripheral Venous Lactate Levels Substitute for Arterial Lactate Levels in The Emergency Department? An Observational Study

10.21203/rs.3.rs-69284/v1 ◽

2020 ◽

Author(s):

Yasufumi Oi ◽

Kosuke Mori ◽

Hidehiro Yamagata ◽

Ayako Nogaki ◽

Tomoaki Takeda ◽

...

Keyword(s):

Emergency Department ◽

Observational Study ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Blood Gas ◽

Altman Analysis ◽

Arterial Lactate ◽

Cutoff Value ◽

Bland Altman Analysis ◽

Lactate Levels

Abstract Background: Arterial lactate (AL) level is an important parameter used to predict patients’ prognosis. AL and peripheral venous lactate (PVL) in blood gas analysis have a low concordance rate, and PVL cannot be used as a substitute for AL. However, if the AL range can be predicted from PVL, PVL may be an alternative method of predicting patient prognosis, and the risk of arterial puncture complications with AL may be reduced. This could become a safe and rapid test method.Methods: This was a retrospective observational study of 143 cases in which blood gas analysis was performed on both arterial blood and venous blood in an emergency department. Spearman's rank correlation coefficient (r) and Bland–Altman analysis were performed. Sensitivity, specificity, and the area under the curve (AUC) were calculated for PVL to predict AL < 2 mmol/L or < 4 mmol/L.Results: The median [interquartile range] AL and PVL were 1.82 [1.25–2.58] vs 2.09 [1.57–3.29], respectively, r was 0.799 (p<0.0001), and a strong correlation was observed; however, Bland–Altman analysis showed disagreement. When AL < 2 mmol/L was used as the outcome, AUC was 0.974, the PVL cutoff value was 2.55 mmol/L, sensitivity was 87.9%, and specificity was 94.1%. If PVL < 2 mmol/L was the outcome, the sensitivity for AL < 2 mmol/L was 100%, and for PVL levels ≥ 3 mmol/L, the specificity was 100%. When AL < 4 mmol/L was used as the outcome, AUC was 0.970, the PVL cutoff value was 3.4 mmol/L, sensitivity was 100%, and specificity was 84.5%. When PVL < 3.5 mmol/L was the outcome, the sensitivity for AL < 4 mmol/L was 100%, and for PVL levels ≥ 4 mmol/L, the specificity was 93.8%.Conclusions: This study revealed that PVL and AL levels in the same critically ill patients do not perfectly agree with each other but are strongly correlated. Furthermore, the high accuracy for predicting AL ranges from PVL levels explains why PVL levels could be used as a substitute for AL level ranges.

Download Full-text