الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Trauma is the third overall cause of death and the first before 40 years of age and is responsible for handicaps and high costs. Most deaths (80%) occurred within 1st 48 h and hemorrhage continues to be one of the two leading causes of death. The main principles of trauma patient care are to recognize and treat hemorrhage early, limit the consequences of shock, and diagnose traumatic lesions. Earlier improvement in lactate clearance (LC) was reported to lead to better prognosis in the treatment of sepsis. In addition, serum lactate-guided intensive care reduces hospital mortality in the treatment of sepsis. Several trauma scores have developed to assess the severity of trauma which is extremely important in early recognition and management of life threating conditions in trauma patients. 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. Several studies have determined the role of lactate elevation and its clearance as predictors of mortality and stay in the intensive care unit (ICU) in cases of sepsis, cardiopulmonary resuscitation, severe burns. Blood lactate levels above 2 mmol/L are proposed as an early and reliable marker of tissue hypoperfusion and, therefore, their measurement would be useful in critically ill patients at risk of developing shock due to any etiology. It has also been postulated that clearance of lactate levels during resuscitation may be a prognostic marker that indicates the patient’s response • to treatment. Persistently elevated lactate seems to be associated with mortality and prolonged hospital stay in trauma patients. We aimed to measure lactate clearance in patients admitted to emergency department ED and compare with the RTS to predict mortality rate in polytrauma patients. This prospective observational study was carried out on 200 Polytrauma patients in the ED in Tanta University Hospital in the period from the first of May 2022 to the end of April 2023. Summary of our results: • The mode of trauma was insignificantly different between both groups. Types of injury were significantly lower in died group than survived group. orthopedic &neurosurgical in 68 (49.64%) survived group and in 15 (23.81%) died group, Orthopedic &cardiothoracic in 8 (5.84%) survived group and in 5 (7.94%) died group. • The respiratory rate, heart rate was significantly higher in died than survived (P = <0.001). The SBP, DBP were significantly lower in died than survived. (P = <0.001). • The GCS was significantly higher in survived than died. (P = <0.001) • The lactate clearance (%) was significantly higher in survived than died. (P = <0.001). • RTS 11 was significantly higher in died patients than survived patients. • Lactate clearance can significantly predict mortality (P <0.001 and AUC = 0.674) at cut-off ≤ 0.44 with 77.78% sensitivity, 48.91% specificity, 41.2% PPV and 82.7%NPV. • RTS can significantly predict mortality (P <0.001 and AUC = 0.787) at cut-off <12 with 77.78% sensitivity, 79.56% specificity, 63.6% PPV and 88.6% NPV. • RTS was significantly better predictor than lactate clearance in prediction of mortality (P value= 0.03).