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Benefits of Initial Limited Crystalloid Resuscitation in Severely Injured Trauma Patients at Emergency Department.

Wang H, Robinson RD, Phillips JL, Kirk AJ, Duane TM, Umejiego J, Stanzer M, Campbell-Furtick MB, Zenarosa NR - J Clin Med Res (2015)

Bottom Line: Patients with LCR (L group, defined as < 2,000 mL) and excessive crystalloid resuscitation (E group, defined as ≥ 2,000 mL) were compared separately in terms of basic demographic, clinical variables, and hospital outcomes.No statistically significant difference was found in terms of basic demographics, vital signs upon arrival at ED, or injury severity between the groups.The correlations between C/PRBC and ED versus ICU versus hospital length of stay (LOS) via Spearman rho were 0.25, 0.22, and 0.22, respectively.

View Article: PubMed Central - PubMed

Affiliation: Department of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.

ABSTRACT

Background: Whether initial limited crystalloid resuscitation (LCR) benefits to all severely injured trauma patients receiving blood transfusions at emergency department (ED) is uncertain. We aimed to determine the role of LCR and its associations with packed red blood cell (PRBC) transfusion during initial resuscitation.

Methods: Trauma patients receiving blood transfusions were reviewed from 2004 to 2013. Patients with LCR (L group, defined as < 2,000 mL) and excessive crystalloid resuscitation (E group, defined as ≥ 2,000 mL) were compared separately in terms of basic demographic, clinical variables, and hospital outcomes. Logistic regression, R-square (R(2)), and Spearman rho correlation were used for analysis.

Results: A total of 633 patients were included. The mortality was 51% in L group and 45% in E group (P = 0.11). No statistically significant difference was found in terms of basic demographics, vital signs upon arrival at ED, or injury severity between the groups. The volume of blood transfused strongly correlated with the volume of crystalloid infused in E group (R(2) = 0.955). Crystalloid to PRBC (C/PRBC) ratio was 0.8 in L group and 1.3 in E group (P < 0.01). The correlations between C/PRBC and ED versus ICU versus hospital length of stay (LOS) via Spearman rho were 0.25, 0.22, and 0.22, respectively.

Conclusions: Similar outcomes were observed in trauma patients receiving blood transfusions regardless of the crystalloid infusion volume. More crystalloid infusions were associated with more blood transfusions. The C/PRBC did not demonstrate predictive value regarding mortality but might predict LOS in severely injured trauma patients.

No MeSH data available.


Related in: MedlinePlus

The comparisons of the amount of crystalloid resuscitation, blood transfusion volume, mortalities, and injury severity scores in trauma patients each year from 2004 until 2013.
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Figure 3: The comparisons of the amount of crystalloid resuscitation, blood transfusion volume, mortalities, and injury severity scores in trauma patients each year from 2004 until 2013.

Mentions: No significant difference was found in terms of early and late mortality when patients received different amounts of crystalloids except those who received more than 6,000 mL of crystalloid infusions at ED (Fig. 2). Moreover, similar injury severities were found between groups except in groups of patients receiving less than 500 mL or more than 6,000 mL of crystalloid. This also resulted in a higher late mortality in group of patients receiving more than 6,000 mL of crystalloid than those without (40% versus 12%, P < 0.01). The amounts of crystalloid infusions and blood transfusions were also investigated separately in each year (2004 - 2013); our findings showed the trend of decreased crystalloid usage while the blood transfusion volumes have not been changed (Fig. 3). Meanwhile, though the mortality tended to improve in recent years in patients with similar injury severity, no statistical significant difference was reached (Fig. 3).


Benefits of Initial Limited Crystalloid Resuscitation in Severely Injured Trauma Patients at Emergency Department.

Wang H, Robinson RD, Phillips JL, Kirk AJ, Duane TM, Umejiego J, Stanzer M, Campbell-Furtick MB, Zenarosa NR - J Clin Med Res (2015)

The comparisons of the amount of crystalloid resuscitation, blood transfusion volume, mortalities, and injury severity scores in trauma patients each year from 2004 until 2013.
© Copyright Policy - open access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4625815&req=5

Figure 3: The comparisons of the amount of crystalloid resuscitation, blood transfusion volume, mortalities, and injury severity scores in trauma patients each year from 2004 until 2013.
Mentions: No significant difference was found in terms of early and late mortality when patients received different amounts of crystalloids except those who received more than 6,000 mL of crystalloid infusions at ED (Fig. 2). Moreover, similar injury severities were found between groups except in groups of patients receiving less than 500 mL or more than 6,000 mL of crystalloid. This also resulted in a higher late mortality in group of patients receiving more than 6,000 mL of crystalloid than those without (40% versus 12%, P < 0.01). The amounts of crystalloid infusions and blood transfusions were also investigated separately in each year (2004 - 2013); our findings showed the trend of decreased crystalloid usage while the blood transfusion volumes have not been changed (Fig. 3). Meanwhile, though the mortality tended to improve in recent years in patients with similar injury severity, no statistical significant difference was reached (Fig. 3).

Bottom Line: Patients with LCR (L group, defined as < 2,000 mL) and excessive crystalloid resuscitation (E group, defined as ≥ 2,000 mL) were compared separately in terms of basic demographic, clinical variables, and hospital outcomes.No statistically significant difference was found in terms of basic demographics, vital signs upon arrival at ED, or injury severity between the groups.The correlations between C/PRBC and ED versus ICU versus hospital length of stay (LOS) via Spearman rho were 0.25, 0.22, and 0.22, respectively.

View Article: PubMed Central - PubMed

Affiliation: Department of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.

ABSTRACT

Background: Whether initial limited crystalloid resuscitation (LCR) benefits to all severely injured trauma patients receiving blood transfusions at emergency department (ED) is uncertain. We aimed to determine the role of LCR and its associations with packed red blood cell (PRBC) transfusion during initial resuscitation.

Methods: Trauma patients receiving blood transfusions were reviewed from 2004 to 2013. Patients with LCR (L group, defined as < 2,000 mL) and excessive crystalloid resuscitation (E group, defined as ≥ 2,000 mL) were compared separately in terms of basic demographic, clinical variables, and hospital outcomes. Logistic regression, R-square (R(2)), and Spearman rho correlation were used for analysis.

Results: A total of 633 patients were included. The mortality was 51% in L group and 45% in E group (P = 0.11). No statistically significant difference was found in terms of basic demographics, vital signs upon arrival at ED, or injury severity between the groups. The volume of blood transfused strongly correlated with the volume of crystalloid infused in E group (R(2) = 0.955). Crystalloid to PRBC (C/PRBC) ratio was 0.8 in L group and 1.3 in E group (P < 0.01). The correlations between C/PRBC and ED versus ICU versus hospital length of stay (LOS) via Spearman rho were 0.25, 0.22, and 0.22, respectively.

Conclusions: Similar outcomes were observed in trauma patients receiving blood transfusions regardless of the crystalloid infusion volume. More crystalloid infusions were associated with more blood transfusions. The C/PRBC did not demonstrate predictive value regarding mortality but might predict LOS in severely injured trauma patients.

No MeSH data available.


Related in: MedlinePlus