الفهرس 
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Abstract
Summary : Trauma-related deaths are one of the top 10 causes of death. Resuscitation in trauma and critically ill patients are challenging. Clinical and laboratory parameters are used to verify the different measurements. The ideal marker or score should be easily available, cost-effective and showing adequacy of resuscitation in record time. The initial surge in lactate values is known to clear over time, and numerous studies have evaluated 6-h and 12-h lactate clearance. However, the trauma surgeon needs an objective indicator of his resuscitation efforts in record time. To find if blood lactate and a 2-h lactate clearance can predict mortality in trauma and to compare these with the available scores in trauma, namely, the revised trauma score (RTS), injury severity score (ISS) and the trauma-related injury severity score (TRISS). The aim the current study was to investigate lactate at ED admission versus revised trauma score maybe useful tool to predict mortality rate and ICU admission in polytrauma patients. This was a case-control study conducted on 200 poly traumatic patients with availability of Blood sampling was performed in all patients who were admitted to emergency medicine department, Mansoura university hospitals after obtaining the approval from (IRB) over a period of 12 months. Serum lactate was collected in tubes before receiving any time of treatment. The analysis was performed within 1 h from blood collection and six hours. This study revealed the following results: • The average age of the studied cases was 44.53±12.15 with M/F ratio was 61.5/38.5. • Motor vehicle collision was the most common mode of trauma followed by fall from height, then blunt trauma to abdomen, chest and face and lastly assaults. In addition, Orthopedic was the most common type of injury, followed abdominal by then cardiothoracic and lastly neurosurgical. • Regarding outcomes, 75% of cases were survived, 65% of cases were admitted to ICU and 84.6% were discharged. • Types of injury, GCS Revised trauma score (11, 12), Lactate first hour, lactate after 6 hours and lactate clearance demonstrated significant correlation with mortality, while the remaining factors not. • Age, sex, Types of injury, RR, DBP, SBP, Revised trauma score (11, 12), Lactate first hour, Lactate after 6 hours and Lactate clearance demonstrated significant correlation with admission to ICU, while the remaining factors not. • Type of injury and Revised trauma score (11 and 12) demonstrated a significant correlation with incidence of discharge from ICU, while the other parameters not. • Revised trauma score could be used as a predictor of ICU admission among studied and its sensitivity, specificity, PPV, NPV and accuracy were 92.0, 47.3, 36.8, 94.7 and 58.5 respectively. • Lactate clearance as well as Revised trauma score could be used as significant predictors for mortality as well as ICU admission with moderate sensitivity and specificity.