Use of prehospital fluids in hypotensive blunt trauma patients

To compare the outcomes of blunt trauma victims with systolic blood pressure < or = 90 mm Hg who received prehospital fluids with the outcomes of those who did not receive prehospital fluids.

This matched-pairs case-control study used records of blunt trauma patients with scene systolic blood pressure < or = 90 mm Hg obtained from the Pennsylvania Trauma Systems Foundation. Patients who received > 500 mL prehospital fluids (n = 75) were matched by Injury Severity Score (ISS) and systolic blood pressure on scene with those who did not receive any prehospital fluids (n = 75). Outcomes compared included change in systolic blood pressure, survival to discharge, and length of hospital stay.

Those who received fluids were more likely to have an increase in systolic blood pressure at arrival to the emergency department [odds ratio for fluid use = 2.41; 95% confidence interval (95% CI) = 1.02, 5.73; p = 0.046]. There was no significant difference in survival to discharge (odds ratio for fluid use = 1.02; 95% CI = 0.40, 2.60; p = 0.969). There was no significant difference in length of hospital stay: 5.4 days (SD = 2.8) for those with fluids; 5.2 days (SD = 2.8) for those with no fluids; difference = 0.2 days; 95% CI = -1.6, 1.8; p = 0.870.

This study suggests that prehospital fluid resuscitation of blunt injured trauma patients with systolic blood pressure < or = 90 increases systolic blood pressure but has no effect on survival or length of hospital stay.