1236. Performance of a Sepsis Screening Triage Tool in Patients with Elevated Lactic Acid Levels: A Retrospective Chart Review
Session: Poster Abstract Session: Sepsis and Critical Care
Saturday, October 22, 2011
Room: Poster Hall B1

Early recognition and treatment of severe sepsis is critical. It is well accepted that an elevated serum lactic acid level is associated with sepsis, strenuous exercise, heart failure, ischemia and/or liver damage. This study’s goal was to assess whether a triage screening tool, in use at Lutheran Medical Center, was able to identify Emergency Department (ED) patients with potential infection who had elevated serum lactate levels.


All medical/surgical admissions from the ED from May to October 2010 with serum lactate of ≥ 4 mmol/l were retrospectively evaluated for possible sepsis.  Patients were screened for sepsis using a 7 component triage screening tool: 1) presence of a suspected infection, 2) temp > 100.4 or < 96.5, 3) HR > 90, 4) RR > 20, 5) alteration of mental status, 6) O2 saturation < 90%, and 7) Syst. BP < 90. Presence of >3 components constituted a positive sepsis screen. Data were collected using the electronic medical record. Each case was divided into one of three groups of admitting diagnoses: infectious, noninfectious, and unknown etiology.


Of the 179 total patients with lactic acid levels > 4 mmol/l, 69 (39%) had an admitting diagnosis of an infectious etiology; 77 (43%) a non-infectious etiology; and 33 (18%) an unknown etiology. Of the 69 patients with an infectious etiology, 48 (70%) were screened in using the triage screening tool. Of those 48 patients, 12 (17%) met three categories, 16 (23%) met four categories, 15 (22%) met five categories, 4 (6%) met six categories, and 1 (1%) met all seven categories. Of the patients with an infectious etiology, 25% screened positive for variances in temperature, compared to 8% and 3% with non-infectious and unknown etiologies, respectively; 47% screened positive for changes in mental status, compared to 68% and 36% with non-infectious and unknown etiologies, respectively; and 26% screened positive for decreased oxygen saturation, compared to 10% and 15% with non-infectious and unknown etiologies, respectively.


The data suggest that our triage screening tool identified 70% of ED patients with a lactate level > 4 mmol/l and an infection-related admission diagnosis. Providers should  use this tool in conjunction with other elements when identifying patients with sepsis.

Subject Category: J. Clinical practice issues

Ramzy Rimawi, MD1, Carlo Palarca, MD1, Nicolas Aquino, MD1, Dhaval Thakkar2, Namita Bhardwaj2, David Tompkins, MD1, Beth Raucher, MD2, Tom-Meka Archinard, MD3 and Michelle Quash, MD3, (1)Internal Medicine, Lutheran Medical Center, Brooklyn, NY, (2)Lutheran Medical Center, Brooklyn, NY, (3)Emergency Medicine, Lutheran Medical Center, Brooklyn, NY


R. Rimawi, None

C. Palarca, None

N. Aquino, None

D. Thakkar, None

N. Bhardwaj, None

D. Tompkins, None

B. Raucher, None

T. M. Archinard, None

M. Quash, None

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