Association between prehospital fluid resuscitation with crystalloids and outcome of trauma patients in Asia by a cross-national multicenter cohort study

Abstract

Prehospital fluid resuscitation with crystalloids in patients following trauma remain controversial. This study aimed to investigate the association between prehospital fluid resuscitation and outcomes of trauma patients in Asia. We conducted a retrospective cohort study of trauma patients between 2016 and 2018 using data from the Pan-Asia Trauma Outcomes Study (PATOS) database. Prehospital fluid resuscitation was defined as any administration of intravenous crystalloid fluid on the ambulance before arrival to hospitals. The outcomes were in-hospital mortality and poor functional outcomes, defined as Modified Rankin Scale ≥ 4. Propensity score matching (PSM) was used to equalize potential prognostic factors in both groups. This study included 31,735 patients from six countries in Asia, and 4318 (13.6%) patients had ever received prehospital fluid resuscitation. The patients receiving prehospital fluid resuscitation had a higher risk of in-hospital mortality, with an adjusted odds ratio (aOR) of 2.02, 95% confidence interval (CI) 1.32–3.10, p = 0.001 in PSM analysis. Prehospital fluid resuscitation was also associated with poor functional outcomes, with an OR 1.73, 95% CI: 1.48–2.03, p < 0.001 in PSM analysis. Prehospital fluid resuscitation in patients with major trauma (injury severity score ≥ 16) presented a higher risk of poor functional outcomes (aOR = 2.65, 95% CI: 1.89–3.73 in PSM analysis, pinteraction = 0.006) via subgroup analysis. Prehospital fluid resuscitation of trauma patients is associated with higher in-hospital mortality and poor functional outcomes in the subgroup in countries studied.

Discriminant ability of the shock index, modified shock index, and reverse shock index multiplied by the Glasgow coma scale on mortality in adult trauma patients: a PATOS retrospective cohort study

“…Even though MRS was originally used for assessing stroke patients’ functional capability 20 , it has been applied to assess trauma patients 15 , 17 . We defined no symptoms, no significant disability, slight disability, and moderate disability (MRS 0–3) as favorable functional outcomes and moderately severe disability, severe disability, and death (MRS 4–6) as poor functional outcomes 15 – 17 , 21 , 22 . Additional analysis of the risk distribution was performed if a superior index was found.…”

Resuscitative practices and the use of low-titer group O whole blood in pediatric trauma

“…These results are consistent with a seminal RCT by Bickell et al 17 who reported that adult trauma patients had worse outcomes if they received prehospital fluids compared with no fluids. A large cross-national report from Asia of more than 30,000 patients found an adjusted increased risk in death in adults who receive more crystalloids in the prehospital phase of resuscitation (adjusted odds ratio [AOR], 2.02; 95% CI, 1.32–3.10) 18 …”

“…A large cross-national report from Asia of more than 30,000 patients found an adjusted increased risk in death in adults who receive more crystalloids in the prehospital phase of resuscitation (adjusted odds ratio [AOR], 2.02; 95% CI, 1.32-3.10). 18…”

The volume of infusion fluids correlates with treatment outcomes in critically ill trauma patients

“…For traumatic injuries, the data is inconsistent and high quality evidence is lacking. Many clinical trials performed in a pre-hospital setting demonstrate that excessive fluid resuscitation improves outcomes ( 15 , 17 ), however, there are also studies that show the opposite result ( 16 , 37 ). However, in most cases the trials are inconclusive and do not support any type of treatment.…”