Resuscitation volume in paediatric non-haemorrhagic blunt trauma.
BACKGROUND
Trauma is a major cause of paediatric morbidity and mortality, yet knowledge of fluid resuscitation is limited. Our objectives were to determine current practises in resuscitation volume (RV) administered to paediatric non-haemorrhagic (NH) blunt trauma patients and to identify fluid related complications.


METHODS
We examined data from 139 trauma patients 1-17 years of age with an injury severity score ≥ 12 resuscitated at a Trauma-designated Children's Hospital. Patients were separated into discreet groups based on ATLS age-dependent vital functions: toddler/preschooler (1-5 years), school age (6-12 years) and adolescent (13-17 years).


RESULTS
The median RV (total fluid intake-maintenance fluid intake) in ml/kg over the first 24h from the time of trauma by age was: 24 (IQR=19-47; 1-5 years); 26 (IQR=15-36; 6-12 years); and 22 (IQR=14-42; 13-17 years). The differences in RV/kg/24h following NH trauma was not significantly different between age groups (p=0.41). Urine output over the 24h ranged from 2.5 (IQR=1.9-3.3; lower age group) to 1.8 (IQR=1.2-2.4; upper age group) ml/kg/h; greater than the ATLS recommended age-dependent targets. Haematocrit was the only significant independent predictor of RV/kg/24h (p<0.001). Fluid-related complications attributable to RV were identified in 12% (n=17/139) of patients, and included ascites (8%; n=11/139) and/or pleural effusion(s) (9%; n=13/139). Patients with fluid-related complications received significantly more RV in ml/kg/24h (42, IQR=27-76) than those without complications (22, IQR=14-36; p=0.001).


CONCLUSIONS
The range of median RV administered to paediatric NH blunt trauma patients with ISS ≥ 12 was 22-26 ml/kg/24h. The RV administered was excessive based on high urine outputs and the presence of fluid-related complications. Further evaluation of RV triggers and endpoints used by paediatric traumatologists is required.
Paediatric Critical Care Medicine, University of Western Ontario, London, ON, Canada.
Abdullah
A
Al-Sharif
Varsha
V
Thakur
Sami
S
Al-Farsi
Ram N
RN
Singh
Alik
A
Kornecki
Jamie A
JA
Seabrook
Douglas D
DD
Fraser
D000293:Adolescent; D017677:Age Distribution; D001201:Ascites / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006400:Hematocrit / Q000379:methods; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D010996:Pleural Effusion / Q000097:blood*; D017410:Practice Guidelines as Topic; D012151:Resuscitation / Q000379:methods*; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000097:blood / Q000175:diagnosis / Q000628:therapy*