Prehospital fluid management of abdominal organ trauma patients—a matched pair analysis
Purpose Severe bleeding after trauma frequently leads to a poor outcome. Prehospital fluid replacement therapy is considered an important primary treatment option. We conducted a retrospective matched pair analysis to assess the influence of prehospital fluid replacement volume on the clinical cours...
Gespeichert in:
| Veröffentlicht in: | Langenbeck's archives of surgery 2015-04, Vol.400 (3), p.371-379 |
|---|---|
| Hauptverfasser: | , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 379 |
|---|---|
| container_issue | 3 |
| container_start_page | 371 |
| container_title | Langenbeck's archives of surgery |
| container_volume | 400 |
| creator | Heuer, Matthias Hussmann, Björn Lefering, Rolf Kaiser, Gernot M. Eicker, Christoph Guckelberger, Olaf Lendemans, Sven |
| description | Purpose
Severe bleeding after trauma frequently leads to a poor outcome. Prehospital fluid replacement therapy is considered an important primary treatment option. We conducted a retrospective matched pair analysis to assess the influence of prehospital fluid replacement volume on the clinical course of patients with solid abdominal organ trauma.
Methods
Data were analyzed from 51,425 patients in TraumaRegister DGU® of the German Trauma Society. Inclusion criteria were as follows: injury severity score ≥16 points, primary admission, age ≥16 years, no isolated brain injury, transfusion of at least one unit of packed red blood cells (pRBCs), and systolic blood pressure ≥20 mmHg at the accident site. The patients were divided into “low-volume” (0–1000 ml) and “high-volume” (≥1500 ml) groups according to the matched pair criteria. In each group, 68 patients met the inclusion criteria.
Results
Higher volume in fluid replacement was associated with increased need for transfusion (pRBCs: low-volume: 7.71 units, high-volume: 9.16 units;
p
= 0.074) and with by trend reduced clotting ability (prothrombin time: low-volume: 71.47 %, high-volume: 66.47 %;
p
= 0.27). The percentage of patients in shock (systolic blood pressure |
| doi_str_mv | 10.1007/s00423-015-1274-2 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1674205753</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1674205753</sourcerecordid><originalsourceid>FETCH-LOGICAL-c414t-a1e9936b22dc66621a583914fcd799b7107b1f97e2bb88ba065f813d34cfe7863</originalsourceid><addsrcrecordid>eNp9kLtOwzAUhi0EoqXwACwoI0vAx9dkRBU3qRIMMDBZTmK3rnIpdjJ04yF4Qp4EVykdmc7ROd__Dx9Cl4BvAGN5GzBmhKYYeApEspQcoSkwylPCOBwfdkYn6CyENcZYyJydognhIgNCsyn6ePVm1YWN63Wd2HpwVdLoVi9NY9o-6Wyii6prXBu_nV_qNum9HhqdbHTvIhF-vr51TPTlylTx6HwS0_U2uHCOTqyug7nYzxl6f7h_mz-li5fH5_ndIi0ZsD7VYPKcioKQqhRCENA8ozkwW1YyzwsJWBZgc2lIUWRZobHgNgNaUVZaIzNBZ-h67N347nMwoVeNC6Wpa92abggKhGQEc8lpRGFES9-F4I1VG-8a7bcKsNoZVaNRFY2qnVFFYuZqXz8UjakOiT-FESAjEOKrXRqv1t3go4TwT-svehyCNw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1674205753</pqid></control><display><type>article</type><title>Prehospital fluid management of abdominal organ trauma patients—a matched pair analysis</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Heuer, Matthias ; Hussmann, Björn ; Lefering, Rolf ; Kaiser, Gernot M. ; Eicker, Christoph ; Guckelberger, Olaf ; Lendemans, Sven</creator><creatorcontrib>Heuer, Matthias ; Hussmann, Björn ; Lefering, Rolf ; Kaiser, Gernot M. ; Eicker, Christoph ; Guckelberger, Olaf ; Lendemans, Sven ; TraumaRegister DGU ; The TraumaRegister DGU</creatorcontrib><description>Purpose
Severe bleeding after trauma frequently leads to a poor outcome. Prehospital fluid replacement therapy is considered an important primary treatment option. We conducted a retrospective matched pair analysis to assess the influence of prehospital fluid replacement volume on the clinical course of patients with solid abdominal organ trauma.
Methods
Data were analyzed from 51,425 patients in TraumaRegister DGU® of the German Trauma Society. Inclusion criteria were as follows: injury severity score ≥16 points, primary admission, age ≥16 years, no isolated brain injury, transfusion of at least one unit of packed red blood cells (pRBCs), and systolic blood pressure ≥20 mmHg at the accident site. The patients were divided into “low-volume” (0–1000 ml) and “high-volume” (≥1500 ml) groups according to the matched pair criteria. In each group, 68 patients met the inclusion criteria.
Results
Higher volume in fluid replacement was associated with increased need for transfusion (pRBCs: low-volume: 7.71 units, high-volume: 9.16 units;
p
= 0.074) and with by trend reduced clotting ability (prothrombin time: low-volume: 71.47 %, high-volume: 66.47 %;
p
= 0.27). The percentage of patients in shock (systolic blood pressure <90 mmHg) upon admission was equal in the two groups (25.0 %;
p
= 1). The mortality rate was discretely higher in the high-volume group (low-volume: 11.8 %, high-volume: 19.1 %;
p
= 0.089).
Conclusions
Excessive prehospital fluid replacement is able to lead in an increased mortality rate in patients with solid abdominal organ injury. Our results support the concept of restrained fluid replacement in the preclinical treatment of severe trauma patients.</description><identifier>ISSN: 1435-2443</identifier><identifier>EISSN: 1435-2451</identifier><identifier>DOI: 10.1007/s00423-015-1274-2</identifier><identifier>PMID: 25681238</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Abdominal Injuries - surgery ; Abdominal Surgery ; Adult ; Blood Transfusion - statistics & numerical data ; Cardiac Surgery ; Female ; Fluid Therapy - adverse effects ; General Surgery ; Germany ; Humans ; Injury Severity Score ; Male ; Matched-Pair Analysis ; Medicine ; Medicine & Public Health ; Original Article ; Preoperative Care - methods ; Prospective Studies ; Prothrombin Time ; Registries ; Retrospective Studies ; Risk Factors ; Shock - complications ; Shock - therapy ; Thoracic Surgery ; Traumatic Surgery ; Treatment Outcome ; Vascular Surgery</subject><ispartof>Langenbeck's archives of surgery, 2015-04, Vol.400 (3), p.371-379</ispartof><rights>Springer-Verlag Berlin Heidelberg 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c414t-a1e9936b22dc66621a583914fcd799b7107b1f97e2bb88ba065f813d34cfe7863</citedby><cites>FETCH-LOGICAL-c414t-a1e9936b22dc66621a583914fcd799b7107b1f97e2bb88ba065f813d34cfe7863</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00423-015-1274-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00423-015-1274-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25681238$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Heuer, Matthias</creatorcontrib><creatorcontrib>Hussmann, Björn</creatorcontrib><creatorcontrib>Lefering, Rolf</creatorcontrib><creatorcontrib>Kaiser, Gernot M.</creatorcontrib><creatorcontrib>Eicker, Christoph</creatorcontrib><creatorcontrib>Guckelberger, Olaf</creatorcontrib><creatorcontrib>Lendemans, Sven</creatorcontrib><creatorcontrib>TraumaRegister DGU</creatorcontrib><creatorcontrib>The TraumaRegister DGU</creatorcontrib><title>Prehospital fluid management of abdominal organ trauma patients—a matched pair analysis</title><title>Langenbeck's archives of surgery</title><addtitle>Langenbecks Arch Surg</addtitle><addtitle>Langenbecks Arch Surg</addtitle><description>Purpose
Severe bleeding after trauma frequently leads to a poor outcome. Prehospital fluid replacement therapy is considered an important primary treatment option. We conducted a retrospective matched pair analysis to assess the influence of prehospital fluid replacement volume on the clinical course of patients with solid abdominal organ trauma.
Methods
Data were analyzed from 51,425 patients in TraumaRegister DGU® of the German Trauma Society. Inclusion criteria were as follows: injury severity score ≥16 points, primary admission, age ≥16 years, no isolated brain injury, transfusion of at least one unit of packed red blood cells (pRBCs), and systolic blood pressure ≥20 mmHg at the accident site. The patients were divided into “low-volume” (0–1000 ml) and “high-volume” (≥1500 ml) groups according to the matched pair criteria. In each group, 68 patients met the inclusion criteria.
Results
Higher volume in fluid replacement was associated with increased need for transfusion (pRBCs: low-volume: 7.71 units, high-volume: 9.16 units;
p
= 0.074) and with by trend reduced clotting ability (prothrombin time: low-volume: 71.47 %, high-volume: 66.47 %;
p
= 0.27). The percentage of patients in shock (systolic blood pressure <90 mmHg) upon admission was equal in the two groups (25.0 %;
p
= 1). The mortality rate was discretely higher in the high-volume group (low-volume: 11.8 %, high-volume: 19.1 %;
p
= 0.089).
Conclusions
Excessive prehospital fluid replacement is able to lead in an increased mortality rate in patients with solid abdominal organ injury. Our results support the concept of restrained fluid replacement in the preclinical treatment of severe trauma patients.</description><subject>Abdominal Injuries - surgery</subject><subject>Abdominal Surgery</subject><subject>Adult</subject><subject>Blood Transfusion - statistics & numerical data</subject><subject>Cardiac Surgery</subject><subject>Female</subject><subject>Fluid Therapy - adverse effects</subject><subject>General Surgery</subject><subject>Germany</subject><subject>Humans</subject><subject>Injury Severity Score</subject><subject>Male</subject><subject>Matched-Pair Analysis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Article</subject><subject>Preoperative Care - methods</subject><subject>Prospective Studies</subject><subject>Prothrombin Time</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Shock - complications</subject><subject>Shock - therapy</subject><subject>Thoracic Surgery</subject><subject>Traumatic Surgery</subject><subject>Treatment Outcome</subject><subject>Vascular Surgery</subject><issn>1435-2443</issn><issn>1435-2451</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kLtOwzAUhi0EoqXwACwoI0vAx9dkRBU3qRIMMDBZTmK3rnIpdjJ04yF4Qp4EVykdmc7ROd__Dx9Cl4BvAGN5GzBmhKYYeApEspQcoSkwylPCOBwfdkYn6CyENcZYyJydognhIgNCsyn6ePVm1YWN63Wd2HpwVdLoVi9NY9o-6Wyii6prXBu_nV_qNum9HhqdbHTvIhF-vr51TPTlylTx6HwS0_U2uHCOTqyug7nYzxl6f7h_mz-li5fH5_ndIi0ZsD7VYPKcioKQqhRCENA8ozkwW1YyzwsJWBZgc2lIUWRZobHgNgNaUVZaIzNBZ-h67N347nMwoVeNC6Wpa92abggKhGQEc8lpRGFES9-F4I1VG-8a7bcKsNoZVaNRFY2qnVFFYuZqXz8UjakOiT-FESAjEOKrXRqv1t3go4TwT-svehyCNw</recordid><startdate>20150401</startdate><enddate>20150401</enddate><creator>Heuer, Matthias</creator><creator>Hussmann, Björn</creator><creator>Lefering, Rolf</creator><creator>Kaiser, Gernot M.</creator><creator>Eicker, Christoph</creator><creator>Guckelberger, Olaf</creator><creator>Lendemans, Sven</creator><general>Springer Berlin Heidelberg</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20150401</creationdate><title>Prehospital fluid management of abdominal organ trauma patients—a matched pair analysis</title><author>Heuer, Matthias ; Hussmann, Björn ; Lefering, Rolf ; Kaiser, Gernot M. ; Eicker, Christoph ; Guckelberger, Olaf ; Lendemans, Sven</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c414t-a1e9936b22dc66621a583914fcd799b7107b1f97e2bb88ba065f813d34cfe7863</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Abdominal Injuries - surgery</topic><topic>Abdominal Surgery</topic><topic>Adult</topic><topic>Blood Transfusion - statistics & numerical data</topic><topic>Cardiac Surgery</topic><topic>Female</topic><topic>Fluid Therapy - adverse effects</topic><topic>General Surgery</topic><topic>Germany</topic><topic>Humans</topic><topic>Injury Severity Score</topic><topic>Male</topic><topic>Matched-Pair Analysis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Article</topic><topic>Preoperative Care - methods</topic><topic>Prospective Studies</topic><topic>Prothrombin Time</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Shock - complications</topic><topic>Shock - therapy</topic><topic>Thoracic Surgery</topic><topic>Traumatic Surgery</topic><topic>Treatment Outcome</topic><topic>Vascular Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Heuer, Matthias</creatorcontrib><creatorcontrib>Hussmann, Björn</creatorcontrib><creatorcontrib>Lefering, Rolf</creatorcontrib><creatorcontrib>Kaiser, Gernot M.</creatorcontrib><creatorcontrib>Eicker, Christoph</creatorcontrib><creatorcontrib>Guckelberger, Olaf</creatorcontrib><creatorcontrib>Lendemans, Sven</creatorcontrib><creatorcontrib>TraumaRegister DGU</creatorcontrib><creatorcontrib>The TraumaRegister DGU</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Langenbeck's archives of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Heuer, Matthias</au><au>Hussmann, Björn</au><au>Lefering, Rolf</au><au>Kaiser, Gernot M.</au><au>Eicker, Christoph</au><au>Guckelberger, Olaf</au><au>Lendemans, Sven</au><aucorp>TraumaRegister DGU</aucorp><aucorp>The TraumaRegister DGU</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prehospital fluid management of abdominal organ trauma patients—a matched pair analysis</atitle><jtitle>Langenbeck's archives of surgery</jtitle><stitle>Langenbecks Arch Surg</stitle><addtitle>Langenbecks Arch Surg</addtitle><date>2015-04-01</date><risdate>2015</risdate><volume>400</volume><issue>3</issue><spage>371</spage><epage>379</epage><pages>371-379</pages><issn>1435-2443</issn><eissn>1435-2451</eissn><abstract>Purpose
Severe bleeding after trauma frequently leads to a poor outcome. Prehospital fluid replacement therapy is considered an important primary treatment option. We conducted a retrospective matched pair analysis to assess the influence of prehospital fluid replacement volume on the clinical course of patients with solid abdominal organ trauma.
Methods
Data were analyzed from 51,425 patients in TraumaRegister DGU® of the German Trauma Society. Inclusion criteria were as follows: injury severity score ≥16 points, primary admission, age ≥16 years, no isolated brain injury, transfusion of at least one unit of packed red blood cells (pRBCs), and systolic blood pressure ≥20 mmHg at the accident site. The patients were divided into “low-volume” (0–1000 ml) and “high-volume” (≥1500 ml) groups according to the matched pair criteria. In each group, 68 patients met the inclusion criteria.
Results
Higher volume in fluid replacement was associated with increased need for transfusion (pRBCs: low-volume: 7.71 units, high-volume: 9.16 units;
p
= 0.074) and with by trend reduced clotting ability (prothrombin time: low-volume: 71.47 %, high-volume: 66.47 %;
p
= 0.27). The percentage of patients in shock (systolic blood pressure <90 mmHg) upon admission was equal in the two groups (25.0 %;
p
= 1). The mortality rate was discretely higher in the high-volume group (low-volume: 11.8 %, high-volume: 19.1 %;
p
= 0.089).
Conclusions
Excessive prehospital fluid replacement is able to lead in an increased mortality rate in patients with solid abdominal organ injury. Our results support the concept of restrained fluid replacement in the preclinical treatment of severe trauma patients.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>25681238</pmid><doi>10.1007/s00423-015-1274-2</doi><tpages>9</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1435-2443 |
| ispartof | Langenbeck's archives of surgery, 2015-04, Vol.400 (3), p.371-379 |
| issn | 1435-2443 1435-2451 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1674205753 |
| source | MEDLINE; SpringerLink Journals |
| subjects | Abdominal Injuries - surgery Abdominal Surgery Adult Blood Transfusion - statistics & numerical data Cardiac Surgery Female Fluid Therapy - adverse effects General Surgery Germany Humans Injury Severity Score Male Matched-Pair Analysis Medicine Medicine & Public Health Original Article Preoperative Care - methods Prospective Studies Prothrombin Time Registries Retrospective Studies Risk Factors Shock - complications Shock - therapy Thoracic Surgery Traumatic Surgery Treatment Outcome Vascular Surgery |
| title | Prehospital fluid management of abdominal organ trauma patients—a matched pair analysis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-05T00%3A29%3A26IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Prehospital%20fluid%20management%20of%20abdominal%20organ%20trauma%20patients%E2%80%94a%20matched%20pair%20analysis&rft.jtitle=Langenbeck's%20archives%20of%20surgery&rft.au=Heuer,%20Matthias&rft.aucorp=TraumaRegister%20DGU&rft.date=2015-04-01&rft.volume=400&rft.issue=3&rft.spage=371&rft.epage=379&rft.pages=371-379&rft.issn=1435-2443&rft.eissn=1435-2451&rft_id=info:doi/10.1007/s00423-015-1274-2&rft_dat=%3Cproquest_cross%3E1674205753%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1674205753&rft_id=info:pmid/25681238&rfr_iscdi=true |