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Operations & systems
Lactate drives prehospital mSOFA risk
Deconstructing the Modified Sequential Organ Failure Assessment (mSOFA) Score: A Decision Tree Analysis Reveals the Pathophysiological Hierarchy of Organ Dysfunction Predictors in Prehospital Critical Care
QJM · 2026-10-12 · Added 13 October 2026
Prospective Spanish multicentre study of 12,212 high-priority patients deconstructed the prehospital mSOFA score with a decision tree, finding lactate ≥3.8 mmol/L was the primary discriminator for 2-day in-hospital mortality, ahead of SaFi, GCS and creatinine.
- Study type
- Cohort
- Design
- Prospective multicentre observational cohort
- Participants
- 12,212 adults transferred at high priority across three Spanish EMS
- Main finding
- Cohort mortality was 5.0%; the decision tree's first split was lactate at 3.8 mmol/L, followed by SaFi, GCS and creatinine (order depending on lactate level)
- Caveat
- Predicts 2-day in-hospital mortality only, and the decision tree hasn't been externally validated outside Spain
- Bottom line
- Hypothesis-generating
Why it matters in Australia (Medium relevance). Point-of-care lactate sits with advanced-care crews in a handful of Australian services, most don't carry it — so this informs critical care practice and score design rather than routine protocols.
Learning goal
Recognise how elevated lactate can sharpen my prehospital risk stratification of critically unwell adults.
More
- Topic: Operations & systems
- Daily scan: 13 October 2026
- Podcast: Paramedic Papers Daily, 13 October 2026
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