title: Emergency department crystalloid resuscitation of 1.5 L or more is associated with increased mortality in elderly and nonelderly trauma patients.
abstract: BACKGROUND
  Recent evidence suggests a survival advantage in trauma patients who receive controlled or hypotensive resuscitation volumes. This study examines the threshold crystalloid volume that is an independent risk factor for mortality after trauma.
  
  
  METHODS
  This study analyzed prospectively collected data from a Level I Trauma Center between January 2000 and December 2008. Demographics and outcomes were compared in elderly (≥70 years) and nonelderly (<70 years) trauma patients who received crystalloid fluid in the emergency department (ED) to determine a threshold volume that was an independent predictor for mortality.
  
  
  RESULTS
  A total of 3,137 patients who received crystalloid resuscitation in the ED were compared. Overall mortality was 5.2%. Mortality among the elderly population was 17.3% (41 deaths), whereas mortality in the nonelderly population was 4% (116 deaths). After multivariate logistic regression analysis, fluid volumes of 1.5 L or more were significantly associated with mortality in both elderly (odds ratio [OR]: 2.89, confidence interval [CI] [1.13-7.41], p=0.027) and nonelderly patients (OR: 2.09, CI [1.31-3.33], p=0.002). Fluid volumes up to 1 L were not associated with significantly increased mortality. At 3 L, mortality was especially pronounced in the elderly (OR: 8.61, CI [1.55-47.75] p=0.014), when compared with the nonelderly (OR=2.69, CI [1.53-4.73], p=0.0006).
  
  
  CONCLUSIONS
  ED volume replacement of 1.5 L or more was an independent risk factor for mortality. High-volume resuscitations were associated with high-mortality particularly in the elderly trauma patient. Our finding supports the notion that excessive fluid resuscitation should be avoided in the ED and when required, operative intervention or intensive care admission should be considered.
authors.affiliation: Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA. eric.ley@cshs.org
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Ley
authors.forename: Morgan A
authors.initials: MA
authors.lastname: Clond
authors.forename: Marissa K
authors.initials: MK
authors.lastname: Srour
authors.forename: Moshe
authors.initials: M
authors.lastname: Barnajian
authors.forename: James
authors.initials: J
authors.lastname: Mirocha
authors.forename: Dan R
authors.initials: DR
authors.lastname: Margulies
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D000077324:Crystalloid Solutions; D005260:Female; D005440:Fluid Therapy / Q000401:mortality*; D006801:Humans; D015601:Injury Severity Score; D007552:Isotonic Solutions / Q000008:administration & dosage / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015532:Rehydration Solutions / Q000008:administration & dosage / Q000627:therapeutic use*; D012151:Resuscitation / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000628:therapy; D055815:Young Adult
chemical_list: D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D015532:Rehydration Solutions