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Prehospital fluid therapy in pediatric trauma patients
S J Teach1, R E Antosia, D P Lund
1Division of Emergency Medicine, Children's Hospital, Boston, USA.
Insights
Prehospital intravenous fluid therapy had minimal impact on pediatric trauma outcomes. Catheter placement in the ambulance, rather than at the scene, reduced on-scene time for these critically injured children.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Care
- Critical Care
Background:
- Prehospital intravenous (IV) fluid administration is a common intervention for pediatric trauma patients.
- The impact of this therapy on patient outcomes and prehospital care intervals remains unclear.
Purpose of the Study:
- To evaluate the effect of prehospital IV fluid therapy on pediatric trauma patient outcomes.
- To assess the influence of prehospital IV fluid therapy on the on-scene interval.
Main Methods:
- Retrospective chart review of 50 pediatric trauma patients (<18 years) admitted to a level I urban pediatric trauma center.
- Data collected included IV fluid administration, catheter placement location (scene vs. ambulance), on-scene interval, and Injury Severity Score (ISS).
- Expert panel assessment of IV fluid therapy's impact on patient outcomes using a novel grading system.
Main Results:
- Prehospital IV fluid therapy was deemed inconsequential to outcome in 94% (47/50) of patients.
- IV fluid therapy was possibly beneficial in 4% (2/50) and possibly detrimental in 2% (1/50) of patients.
- Patients receiving IV catheters at the scene had significantly longer on-scene intervals (15.4 min) compared to those receiving them in the ambulance (11.4 min).
Conclusions:
- Prehospital IV fluid therapy appears to have a limited impact on outcomes for pediatric trauma patients in an urban setting.
- Ambulance-based IV catheter placement is associated with shorter on-scene times, potentially improving efficiency of care.
- The role and necessity of prehospital IV fluid therapy in this population warrant further investigation and reevaluation.
Abstract:
In order to evaluate the impact of prehospital intravenous fluid therapy on the outcome of pediatric trauma patients and to evaluate the effect of such therapy on the on-scene interval, we performed a retrospective chart review of 50 pediatric trauma patients less than 18 years old transported directly from the field by Emergency Medical Services personnel with an intravenous catheter in place and admitted to the Trauma Service of a level I urban pediatric trauma center. As judged by an expert panel using a new grading system, prehospital intravenous fluid therapy was inconsequential to outcome in 47 of 50 patients, possibly beneficial in two of 50 patients, and possibly detrimental in one of 50 patients. Patients who received their catheters at the scene had significantly longer on-scene intervals than those who received them in the ambulance (15.4 vs 11.4 minutes, P < 0.05). The mean volume of fluid administered was 4.4 ml/kg body weight. Placement of the catheter (at the scene vs in the ambulance) and prehospital fluid volume administered were independent of the Injury Severity Score. The role of prehospital fluid therapy in pediatric trauma patients in an urban setting requires reevaluation.