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Influence of prehospital volume replacement on outcome in polytraumatized children
Insights
Excessive prehospital fluid replacement in severely injured children may worsen outcomes. Higher fluid volumes were linked to increased transfusion needs, reduced coagulation, and elevated mortality rates, suggesting a need for cautious fluid administration in pediatric trauma care.
Area of Science:
- Pediatric Trauma Care
- Emergency Medicine
- Resuscitation Science
Background:
- Severe bleeding in children post-trauma is associated with poor outcomes.
- Prehospital fluid replacement is a critical initial treatment for trauma patients.
- Understanding fluid therapy's impact on pediatric trauma is essential for improving survival rates.
Purpose of the Study:
- To evaluate the effect of prehospital fluid replacement therapy on the clinical course of severely injured children.
- To analyze the association between fluid volume administered and patient outcomes in pediatric trauma.
- To investigate the influence of fluid resuscitation on coagulation and mortality in pediatric trauma patients.
Main Methods:
- Retrospective analysis of 67,782 patients from the TraumaRegister DGU®.
- Inclusion criteria: Injury Severity Score ≥16, age 1-15 years, systolic blood pressure ≥20 mmHg, and pRBC transfusion.
- Patients were stratified into subgroups based on prehospital fluid volume administered and matched for key variables.
Main Results:
- Higher prehospital fluid volumes correlated with increased need for packed red blood cells (pRBC) transfusion.
- Increased fluid administration was associated with reduced blood coagulation ability.
- Elevated fluid volumes showed a trend towards higher mortality and multiple organ failure rates.
Conclusions:
- Excessive prehospital fluid replacement in pediatric trauma may lead to adverse clinical outcomes.
- A tendency towards increased mortality and impaired coagulation was observed with higher fluid volumes.
- Findings suggest a need for careful consideration of fluid administration volumes in prehospital pediatric trauma management.
Introduction:
Severe bleeding after trauma frequently results in poor outcomes in children. Prehospital fluid replacement therapy is regarded as an important primary treatment option. Our study aimed, through a retrospective analysis of matched pairs, to assess the influence of prehospital fluid replacement therapy on the post-traumatic course of severely injured children.
Methods:
The data for 67,782 patients from the TraumaRegister DGU® of the German Trauma Society were analyzed. The following inclusion criteria were applied: injury severity score ≥16 points, primary admission, age 1 to 15 years old, systolic blood pressure ≥20 mmHg at the accident site and transfusion of at least one unit of packed red blood cells (pRBC) in the emergency trauma room prior to intensive care admission. As volume replacement therapy depends on age and body weight, especially in children, three subgroups were formed according to the mean value of the administered prehospital volume. The children were matched and enrolled into two groups according to the following criteria: intubation at the accident site (yes/no), Abbreviated Injury Scale (four body regions), accident year, systolic blood pressure and age group.
Results:
A total of 31 patients in each group met the inclusion criteria. An increase in volume replacement was associated with an elevated need for a transfusion (≥10 pRBC: low volume, 9.7%; high volume, 25.8%; P = 0.18) and a reduction in the ability to coagulate (prothrombin time ratio: low volume, 58.7%; high volume, 55.6%; P = 0.23; prothrombin time: low volume, 42.2 seconds; high volume, 50.1 seconds; P = 0.38). With increasing volume, the mortality (low volume, 19.4%; high volume, 25.8%; P = 0.75) and multiple organ failure rates (group 1, 36.7%; group 2, 41.4%; P = 0.79) increased. With increased volume, the rescue time also increased (low volume, 62 minutes; high volume, 71.5 minutes; P = 0.21).
Conclusion:
For the first time, a tendency was shown that excessive prehospital fluid replacement in children leads to a worse clinical course with higher mortality and that excessive fluid replacement has a negative influence on the ability to coagulate.
