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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 association of C/PRBC ratio and the length of ED, ICU, and hospitalization using confidence band around regression prediction.
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Figure 5: The association of C/PRBC ratio and the length of ED, ICU, and hospitalization using confidence band around regression prediction.

Mentions: Our results showed no significant difference of crystalloid resuscitation in L group, despite blood transfusion volume received in the ED (P > 0.05). However, the volume of crystalloid given in E group was strongly correlated with the blood transfusion volume (R2 = 0.955, P < 0.05) (Fig. 4). Moderate correlations were found between C/PRBC ratios and ED, ICU, and in-hospital LOS among all trauma patients in this study (Fig. 5).


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 association of C/PRBC ratio and the length of ED, ICU, and hospitalization using confidence band around regression prediction.
© Copyright Policy - open access
Related In: Results  -  Collection

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

Figure 5: The association of C/PRBC ratio and the length of ED, ICU, and hospitalization using confidence band around regression prediction.
Mentions: Our results showed no significant difference of crystalloid resuscitation in L group, despite blood transfusion volume received in the ED (P > 0.05). However, the volume of crystalloid given in E group was strongly correlated with the blood transfusion volume (R2 = 0.955, P < 0.05) (Fig. 4). Moderate correlations were found between C/PRBC ratios and ED, ICU, and in-hospital LOS among all trauma patients in this study (Fig. 5).

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