Point-of-care lactate adds to prediction of outcome in children with WHO emergency signs in a low- and middle-income setting.

A prospective study of 96 children with one or more WHO emergency signs presenting to a children's emergency department in Papua New Guinea, the case mix included sepsis, pneumonia, malaria, diarrhoea and encephalopathy. Thirty children died during admission. Using a hand-held point-of-care device, a single capillary blood lactate level was measured at the time of presentation. Five clinical signs and capillary blood lactate predicted mortality, and lactate and a low Glasgow Coma Score were the strongest predictors. The mortality rate for a capillary lactate level <5 mmol/L was 7/45 (15%), and if lactate ≥ 5 mmol/L, the mortality rate was 22/52 (42%). When point-of-care lactate is integrated with clinical features of GCS ≤ 13, cold peripheries (or prolonged capillary refill), and low oxygen saturation (or obstructed breathing), high‑risk children can be identified and prioritised for urgent management in a paediatric intensive care unit or area of the ward.