Citation

Hussmann B, Lefering R, Kauther MD, Ruchholtz S, Moldzio P, Lendemans S, Dgu T. Crit. Care 2012; 16(5): R201.

Copyright

(Copyright © 2012, Holtzbrinck Springer Nature Publishing Group - BMC)

DOI

10.1186/cc11809

PMID

23078792

Abstract

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 of 67.782 patients from the TraumaRegister DGU(R) of the German Trauma Society were analyzed. The following inclusion criteria were applied: injury severity score [greater than or equal to] 16 points, primary admission, age 1-15 years old, systolic blood pressure [greater than or equal to] 20 mm Hg 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. It was found that an increase in volume replacement was associated with an elevated need for a transfusion ([greater than or equal to] 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; PTT: 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, rescue time also increased (low volume 62 minutes, high volume 71.5, p = 0.21). CONCLUSIONS: 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.

Language: en