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Prehospital fluid management of abdominal organ trauma patients—a matched pair analysis

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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.

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Acknowledgments

We would like to thank the members of the Polytrauma Study Group of the German Trauma Society for their many years of hard work on TraumaRegister DGU®. At the beginning of 2008, the Polytrauma Study Group was integrated into the Committee on Emergency Medicine, Intensive Care and Trauma Management of the German Trauma Society (Sektion NIS).

Participating hospitals

The clinics that provided to the TraumaRegister DGU® data for this analysis can be found at www.traumaregister.de. We thank the clinics for their cooperation.

Conflicts of interest

The authors declare that there are no conflicts of interests.

Author contributions

Matthias Heuer, MD, Ph.D, is responsible in the study conception and design; acquisition, analysis, and interpretation of data; and drafting of the manuscript. Björn Hussmann, MD, contributed in the critical revision of manuscript. Rolf Lefering contributed in the acquisition, analysis, and interpretation of data and critical revision of the manuscript. Gernot M. Kaiser, MD, and Christoph Eicker, MD, contributed in the critical revision of the manuscript. Olaf Guckelberger, MD, and Sven Lendemans, MD, helped in the study conception and design, analysis and interpretation of data, and critical revision of the manuscript.

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Authors and Affiliations

  1. Department of General and Visceral Surgery, Center of Minimal Invasive Surgery, Catholic Hospital of Essen, Hülsmannstrasse 17, 45355, Essen, Germany

    Matthias Heuer & Olaf Guckelberger

  2. Department of Trauma Surgery, University Hospital of Essen, Hufelandstrasse 55, 45122, Essen, Germany

    Björn Hussmann & Sven Lendemans

  3. Institute for Research in Operative Medicine, University of Witten/Herdecke, Campus Cologne-Merheim, Ostmerheimer Str. 200, 51109, Cologne, Germany

    Rolf Lefering

  4. Department of General, Visceral and Transplantation Surgery, University Hospital of Essen, Hufelandstrasse 55, 45122, Essen, Germany

    Gernot M. Kaiser

  5. Department of Orthopedic and Trauma Surgery, Catholic Hospital of Essen, Hülsmannstrasse 17, 45355, Essen, Germany

    Christoph Eicker

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  1. Matthias Heuer
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  2. Björn Hussmann
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  3. Rolf Lefering
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  6. Olaf Guckelberger
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  7. Sven Lendemans
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The TraumaRegister DGU

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Correspondence to Matthias Heuer.

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Heuer, M., Hussmann, B., Lefering, R. et al. Prehospital fluid management of abdominal organ trauma patients—a matched pair analysis. Langenbecks Arch Surg 400, 371–379 (2015). https://doi.org/10.1007/s00423-015-1274-2

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  • DOI: https://doi.org/10.1007/s00423-015-1274-2

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