Prehospital fluid resuscitation in patients with severe burns - A nationwide cohort study

Prehospital fluid administration is widely used in patients with severe burns to stabilize hemodynamics and organ perfusion, but its effect on outcomes remains unclear. We examined the association between prehospital fluid administration and early mortality in patients with severe burns.

In this retrospective observational study using Japan's nationwide trauma registry, we identified patients with severe burns - defined as burns involving ≥ 20% of the total body surface area (TBSA) in patients 5 years of age or older, or ≥ 10% in younger children - who were transported directly from the scene of injury between January 2019 and December 2023. The primary outcome was death from any cause within 48 h after hospital arrival; the secondary outcome was in-hospital all-cause mortality. Missing covariate values were handled by multiple imputation, and confounding was addressed with stabilized inverse probability weighting based on propensity scores. Effect estimates were expressed as odds ratios with cluster-robust 95% confidence intervals.

Of the 884 patients analyzed, 94 (10.6%) received prehospital fluid administration. Early death occurred in 22 of 94 patients (23.4%) in the fluid group and in 106 of 790 patients (13.4%) in the non-fluid group; in-hospital mortality occurred in 42 (44.7%) and 224 (28.4%), respectively. After adjustment, the odds ratios for 48-hour and in-hospital deaths related to prehospital fluid administration were 0.88 (95% confidence interval, 0.32-2.39) and 1.30 (95% confidence interval, 0.75-2.25), respectively.

Among patients with severe burns, prehospital fluid administration was not significantly associated with early or in-hospital mortality.