Enhanced prehospital volume therapy does not lead to improved outcomes in severely injured patients with severe traumatic brain injury.
BMC Emerg Med
; 19(1): 13, 2019 01 23.
Article
em En
| MEDLINE
| ID: mdl-30674281
ABSTRACT
BACKGROUND:
Whether enhanced prehospital volume therapy leads to outcome improvements in severely injured patients with severe traumatic brain injury (TBI) remains controversial. The aim of this study was to investigate the influence of prehospital volume therapy on the clinical course of severely injured patients with severe TBI.METHODS:
Data for 122,672 patients from TraumaRegister DGU® (TR-DGU) was analyzed. Inclusion criteria were defined as follows Injury Severety Score (ISS) ≥ 16, primary admission, age ≥ 16 years, Abbreviated Injury Scale (AIS) head ≥3, administration of at least one unit of packed red blood cells (pRBCs), and available volume and blood pressure data. Stratification based on the following matched-pair criteria was performed group 1 prehospital volumes of 0-1000 ml; group 2 prehospital volumes of ≥1501 ml; AIS head (3, 4, 5 + 6 and higher than for other body regions); age (16-54, 55-69, ≥ 70 years); gender; prehospital intubation (yes/no); emergency treatment time +/- 30 min.; rescue resources (rescue helicopter, emergency ambulance); blood pressure (20-60, 61-90, ≥ 91 mmHg); year of accident (2002-2005, 2006-2009, 2010-2012); AIS thorax, abdomen, and extremities plus pelvis.RESULTS:
A total of 169 patients per group fulfilled the inclusion criteria. Increasing volume administration was associated with reduced coagulation capability and reduced hemoglobin (Hb) levels (prothrombin ratio group 1 68%, group 2 63.7%; p ≤ 0.04; Hb group 1 11.2 mg/dl, group 2 10.2 mg/dl; p ≤ 0.001). It was not possible to show a significant reduction in the mortality rate with increasing volumes (group 1 45.6, group 2 45.6; p = 1).CONCLUSIONS:
The data presented in this study demonstrates that prehospital volume administration of more than 1500 ml does not improve severely injured patients with severe traumatic brain injury (TBI).Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Coloides
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Serviços Médicos de Emergência
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Hidratação
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Lesões Encefálicas Traumáticas
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Soluções Cristaloides
Limite:
Adolescent
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Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
BMC Emerg Med
Assunto da revista:
MEDICINA DE EMERGENCIA
Ano de publicação:
2019
Tipo de documento:
Article
País de afiliação:
Alemanha