Prehospital intravenous fluid is associated with increased survival in trauma patients

David A. Hampton, Löic J. Fabricant, Jerry Differding, Brian Diggs, Samantha Underwood, Dodie De La Cruz, John B. Holcomb, Karen Brasel, Mitchell J. Cohen, Erin E. Fox, Louis H. Alarcon, Mohammad H. Rahbar, Herb A. Phelan, Eileen M. Bulger, Peter Muskat, John G. Myers, Deborah J. Del Junco, Charles E. Wade, Bryan A. Cotton, Martin Schreiber

    Research output: Contribution to journalArticle

    46 Citations (Scopus)

    Abstract

    BACKGROUND: Delivery of intravenous crystalloid fluids (IVF) remains a tradition-based priority during prehospital resuscitation of trauma patients. Hypotensive and targeted resuscitation algorithms have been shown to improve patient outcomes. We hypothesized that receiving any prehospital IVF is associated with increased survival in trauma patients compared with receiving no prehospital IVF. METHODS: Prospective data from 10 Level 1 trauma centers were collected. Patient demographics, prehospital IVF volume, prehospital and emergency department vital signs, lifesaving interventions, laboratory values, outcomes, and complications were collected and analyzed. Patients who did or did not receive prehospital IVF were compared. Tests for nonparametric data were used to assess significant differences between groups (p ≤ 0.05). Cox regression analyses were performed to determine the independent influence of IVF on outcome and complications. RESULTS: The study population consisted of 1,245 trauma patients; 45 were excluded owing to incomplete data; 84% (n = 1,009) received prehospital IVF, and 16% (n = 191) did not. There was no difference between the groups with respect to sex, age, and Injury Severity Score (ISS). The on-scene systolic blood pressurewas lower in the IVF group (110mmHg vs. 100mmHg, p <0.04) and did not change significantly after IVF, measured at emergency department admission (110 mm Hg vs. 105 mm Hg, p = 0.05). Hematocrit/hemoglobin, fibrinogen, and platelets were lower (p <0.05), and prothrombin time/ international normalized ratio and partial thromboplastin time were higher (p <0.001) in the IVF group. The IVF group received a median fluid volume of 700 mL (interquartile range, 300-1,300). The Cox regression revealed that prehospital fluid administration was associated with increased survival (hazard ratio, 0.84; 95% confidence interval, 0.72-0.98; p = 0.03). Site differences in ISS and fluid volumes were demonstrated (p <0.001). CONCLUSION: Prehospital IVF volumes commonly used by PRospective Observational Multicenter Massive Transfusion Study (PROMMTT) investigators do not result in increased systolic blood pressure but are associated with decreased in-hospital mortality in trauma patients compared with patients who did not receive prehospital IVF.

    Original languageEnglish (US)
    JournalJournal of Trauma and Acute Care Surgery
    Volume75
    Issue number1 SUPPL1
    DOIs
    StatePublished - 2013

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    Survival
    Wounds and Injuries
    Injury Severity Score
    Resuscitation
    crystalloid solutions
    Hospital Emergency Service
    Blood Pressure
    International Normalized Ratio
    Partial Thromboplastin Time
    Vital Signs
    Trauma Centers
    Prothrombin Time
    Hospital Mortality
    Hematocrit
    Fibrinogen
    Hemoglobins
    Blood Platelets
    Regression Analysis
    Research Personnel
    Demography

    Keywords

    • Clinical parameters
    • Prehospital
    • PROMMTT
    • Resuscitation

    ASJC Scopus subject areas

    • Critical Care and Intensive Care Medicine
    • Surgery

    Cite this

    Prehospital intravenous fluid is associated with increased survival in trauma patients. / Hampton, David A.; Fabricant, Löic J.; Differding, Jerry; Diggs, Brian; Underwood, Samantha; De La Cruz, Dodie; Holcomb, John B.; Brasel, Karen; Cohen, Mitchell J.; Fox, Erin E.; Alarcon, Louis H.; Rahbar, Mohammad H.; Phelan, Herb A.; Bulger, Eileen M.; Muskat, Peter; Myers, John G.; Del Junco, Deborah J.; Wade, Charles E.; Cotton, Bryan A.; Schreiber, Martin.

    In: Journal of Trauma and Acute Care Surgery, Vol. 75, No. 1 SUPPL1, 2013.

    Research output: Contribution to journalArticle

    Hampton, DA, Fabricant, LJ, Differding, J, Diggs, B, Underwood, S, De La Cruz, D, Holcomb, JB, Brasel, K, Cohen, MJ, Fox, EE, Alarcon, LH, Rahbar, MH, Phelan, HA, Bulger, EM, Muskat, P, Myers, JG, Del Junco, DJ, Wade, CE, Cotton, BA & Schreiber, M 2013, 'Prehospital intravenous fluid is associated with increased survival in trauma patients', Journal of Trauma and Acute Care Surgery, vol. 75, no. 1 SUPPL1. https://doi.org/10.1097/TA.0b013e318290cd52
    Hampton, David A. ; Fabricant, Löic J. ; Differding, Jerry ; Diggs, Brian ; Underwood, Samantha ; De La Cruz, Dodie ; Holcomb, John B. ; Brasel, Karen ; Cohen, Mitchell J. ; Fox, Erin E. ; Alarcon, Louis H. ; Rahbar, Mohammad H. ; Phelan, Herb A. ; Bulger, Eileen M. ; Muskat, Peter ; Myers, John G. ; Del Junco, Deborah J. ; Wade, Charles E. ; Cotton, Bryan A. ; Schreiber, Martin. / Prehospital intravenous fluid is associated with increased survival in trauma patients. In: Journal of Trauma and Acute Care Surgery. 2013 ; Vol. 75, No. 1 SUPPL1.
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    abstract = "BACKGROUND: Delivery of intravenous crystalloid fluids (IVF) remains a tradition-based priority during prehospital resuscitation of trauma patients. Hypotensive and targeted resuscitation algorithms have been shown to improve patient outcomes. We hypothesized that receiving any prehospital IVF is associated with increased survival in trauma patients compared with receiving no prehospital IVF. METHODS: Prospective data from 10 Level 1 trauma centers were collected. Patient demographics, prehospital IVF volume, prehospital and emergency department vital signs, lifesaving interventions, laboratory values, outcomes, and complications were collected and analyzed. Patients who did or did not receive prehospital IVF were compared. Tests for nonparametric data were used to assess significant differences between groups (p ≤ 0.05). Cox regression analyses were performed to determine the independent influence of IVF on outcome and complications. RESULTS: The study population consisted of 1,245 trauma patients; 45 were excluded owing to incomplete data; 84{\%} (n = 1,009) received prehospital IVF, and 16{\%} (n = 191) did not. There was no difference between the groups with respect to sex, age, and Injury Severity Score (ISS). The on-scene systolic blood pressurewas lower in the IVF group (110mmHg vs. 100mmHg, p <0.04) and did not change significantly after IVF, measured at emergency department admission (110 mm Hg vs. 105 mm Hg, p = 0.05). Hematocrit/hemoglobin, fibrinogen, and platelets were lower (p <0.05), and prothrombin time/ international normalized ratio and partial thromboplastin time were higher (p <0.001) in the IVF group. The IVF group received a median fluid volume of 700 mL (interquartile range, 300-1,300). The Cox regression revealed that prehospital fluid administration was associated with increased survival (hazard ratio, 0.84; 95{\%} confidence interval, 0.72-0.98; p = 0.03). Site differences in ISS and fluid volumes were demonstrated (p <0.001). CONCLUSION: Prehospital IVF volumes commonly used by PRospective Observational Multicenter Massive Transfusion Study (PROMMTT) investigators do not result in increased systolic blood pressure but are associated with decreased in-hospital mortality in trauma patients compared with patients who did not receive prehospital IVF.",
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    author = "Hampton, {David A.} and Fabricant, {L{\"o}ic J.} and Jerry Differding and Brian Diggs and Samantha Underwood and {De La Cruz}, Dodie and Holcomb, {John B.} and Karen Brasel and Cohen, {Mitchell J.} and Fox, {Erin E.} and Alarcon, {Louis H.} and Rahbar, {Mohammad H.} and Phelan, {Herb A.} and Bulger, {Eileen M.} and Peter Muskat and Myers, {John G.} and {Del Junco}, {Deborah J.} and Wade, {Charles E.} and Cotton, {Bryan A.} and Martin Schreiber",
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    doi = "10.1097/TA.0b013e318290cd52",
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    TY - JOUR

    T1 - Prehospital intravenous fluid is associated with increased survival in trauma patients

    AU - Hampton, David A.

    AU - Fabricant, Löic J.

    AU - Differding, Jerry

    AU - Diggs, Brian

    AU - Underwood, Samantha

    AU - De La Cruz, Dodie

    AU - Holcomb, John B.

    AU - Brasel, Karen

    AU - Cohen, Mitchell J.

    AU - Fox, Erin E.

    AU - Alarcon, Louis H.

    AU - Rahbar, Mohammad H.

    AU - Phelan, Herb A.

    AU - Bulger, Eileen M.

    AU - Muskat, Peter

    AU - Myers, John G.

    AU - Del Junco, Deborah J.

    AU - Wade, Charles E.

    AU - Cotton, Bryan A.

    AU - Schreiber, Martin

    PY - 2013

    Y1 - 2013

    N2 - BACKGROUND: Delivery of intravenous crystalloid fluids (IVF) remains a tradition-based priority during prehospital resuscitation of trauma patients. Hypotensive and targeted resuscitation algorithms have been shown to improve patient outcomes. We hypothesized that receiving any prehospital IVF is associated with increased survival in trauma patients compared with receiving no prehospital IVF. METHODS: Prospective data from 10 Level 1 trauma centers were collected. Patient demographics, prehospital IVF volume, prehospital and emergency department vital signs, lifesaving interventions, laboratory values, outcomes, and complications were collected and analyzed. Patients who did or did not receive prehospital IVF were compared. Tests for nonparametric data were used to assess significant differences between groups (p ≤ 0.05). Cox regression analyses were performed to determine the independent influence of IVF on outcome and complications. RESULTS: The study population consisted of 1,245 trauma patients; 45 were excluded owing to incomplete data; 84% (n = 1,009) received prehospital IVF, and 16% (n = 191) did not. There was no difference between the groups with respect to sex, age, and Injury Severity Score (ISS). The on-scene systolic blood pressurewas lower in the IVF group (110mmHg vs. 100mmHg, p <0.04) and did not change significantly after IVF, measured at emergency department admission (110 mm Hg vs. 105 mm Hg, p = 0.05). Hematocrit/hemoglobin, fibrinogen, and platelets were lower (p <0.05), and prothrombin time/ international normalized ratio and partial thromboplastin time were higher (p <0.001) in the IVF group. The IVF group received a median fluid volume of 700 mL (interquartile range, 300-1,300). The Cox regression revealed that prehospital fluid administration was associated with increased survival (hazard ratio, 0.84; 95% confidence interval, 0.72-0.98; p = 0.03). Site differences in ISS and fluid volumes were demonstrated (p <0.001). CONCLUSION: Prehospital IVF volumes commonly used by PRospective Observational Multicenter Massive Transfusion Study (PROMMTT) investigators do not result in increased systolic blood pressure but are associated with decreased in-hospital mortality in trauma patients compared with patients who did not receive prehospital IVF.

    AB - BACKGROUND: Delivery of intravenous crystalloid fluids (IVF) remains a tradition-based priority during prehospital resuscitation of trauma patients. Hypotensive and targeted resuscitation algorithms have been shown to improve patient outcomes. We hypothesized that receiving any prehospital IVF is associated with increased survival in trauma patients compared with receiving no prehospital IVF. METHODS: Prospective data from 10 Level 1 trauma centers were collected. Patient demographics, prehospital IVF volume, prehospital and emergency department vital signs, lifesaving interventions, laboratory values, outcomes, and complications were collected and analyzed. Patients who did or did not receive prehospital IVF were compared. Tests for nonparametric data were used to assess significant differences between groups (p ≤ 0.05). Cox regression analyses were performed to determine the independent influence of IVF on outcome and complications. RESULTS: The study population consisted of 1,245 trauma patients; 45 were excluded owing to incomplete data; 84% (n = 1,009) received prehospital IVF, and 16% (n = 191) did not. There was no difference between the groups with respect to sex, age, and Injury Severity Score (ISS). The on-scene systolic blood pressurewas lower in the IVF group (110mmHg vs. 100mmHg, p <0.04) and did not change significantly after IVF, measured at emergency department admission (110 mm Hg vs. 105 mm Hg, p = 0.05). Hematocrit/hemoglobin, fibrinogen, and platelets were lower (p <0.05), and prothrombin time/ international normalized ratio and partial thromboplastin time were higher (p <0.001) in the IVF group. The IVF group received a median fluid volume of 700 mL (interquartile range, 300-1,300). The Cox regression revealed that prehospital fluid administration was associated with increased survival (hazard ratio, 0.84; 95% confidence interval, 0.72-0.98; p = 0.03). Site differences in ISS and fluid volumes were demonstrated (p <0.001). CONCLUSION: Prehospital IVF volumes commonly used by PRospective Observational Multicenter Massive Transfusion Study (PROMMTT) investigators do not result in increased systolic blood pressure but are associated with decreased in-hospital mortality in trauma patients compared with patients who did not receive prehospital IVF.

    KW - Clinical parameters

    KW - Prehospital

    KW - PROMMTT

    KW - Resuscitation

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