The Association of Prehospital Intravenous Fluids and Mortality in Patients with Penetrating Trauma.
J Emerg Med
; 54(4): 487-499.e6, 2018 04.
Article
in En
| MEDLINE
| ID: mdl-29501219
ABSTRACT
BACKGROUND:
The optimal approach to prehospital care of trauma patients is controversial, and thought to require balancing advanced field interventions with rapid transport to definitive care.OBJECTIVE:
We sought principally to examine any association between the amount of prehospital IV fluid (IVF) administered and mortality.METHODS:
We conducted a retrospective cohort analysis of trauma registry data patients who sustained penetrating trauma between January 2008 and February 2011, as identified in the Pennsylvania Trauma Systems Foundation registry with corresponding prehospital records from the Philadelphia Fire Department. Analyses were conducted with logistic regression models and instrumental variable analysis, adjusted for injury severity using scene vital signs before the intervention was delivered.RESULTS:
There were 1966 patients identified. Overall mortality was 22.60%. Approximately two-thirds received fluids and one-third did not. Both cohorts had similar Trauma and Injury Severity Score-predicted mortality. Mortality was similar in those who received IVF (23.43%) and those who did not (21.30%) (p = 0.212). Patients who received IVF had longer mean scene times (10.82 min) than those who did not (9.18 min) (p < 0.0001), although call times were similar in those who received IVF (24.14 min) and those who did not (23.83 min) (p = 0.637). Adjusted analysis of 1722 patients demonstrated no benefit or harm associated with prehospital fluid (odds ratio [OR] 0.905, 95% confidence interval [CI] 0.47-1.75). Instrumental variable analysis utilizing variations in use of IVF across different Emergency Medical Services (EMS) units also found no association between the unit's percentage of patients that were provided fluids and mortality (OR 1.02, 95% CI 0.96-1.08).CONCLUSIONS:
We found no significant difference in mortality or EMS call time between patients who did or did not receive prehospital IVF after penetrating trauma.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Resuscitation
/
Wounds, Penetrating
/
Emergency Medical Services
/
Fluid Therapy
Type of study:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Adolescent
/
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
America do norte
Language:
En
Journal:
J Emerg Med
Journal subject:
MEDICINA DE EMERGENCIA
Year:
2018
Document type:
Article