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To study serumlactate and its role as an useful indicator on admission to the emergency department (ED) and its role in medical decision in the ED. In a university Accident and Emergency Department (ED) patients with high serumlactate >5.0 mmol/L (n=180) and a control group (n=180) matched for age and with normal lactate on admission to the ED was investigated. As a clinical decision system for emergency care we used the METTS protocol. In the high lactate group mortality was higher and hospital stay was significantly increased as compared with those with normal serumlactate on admission to the ED. Vital signs such as respiratory rate, oxygen saturation, heart rate, blood pressure and reaction level scale indicate that signs of systemic organ failure was more common among those with high serum lactate. Those with high serum lactate had also a higher priority level, according to the METTS protocol, than those with normal lactate. In the METTS protocol lactate is also used as an indicator in the re evaluation of priority level, and in patients with >5 mmol/l orange priority is given. In this study it was shown that those with high serum lactate levels at admission to the emergency department also had an increased mortality rate, signs of organ failure and longer hospital stay. Furthermore, it was also shown that the METTS protocol also includes a sensitive laboratory algorithm to identify an increased risk or signs of organ failure on admission.

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