title: Does increased prehospital replacement volume lead to a poor clinical course and an increased mortality? A matched-pair analysis of 1896 patients of the Trauma Registry of the German Society for Trauma Surgery who were managed by an emergency doctor at the accident site.
abstract: BACKGROUND
  Severe bleeding after trauma frequently leads to a poor outcome. Prehospital fluid replacement therapy is regarded as an important primary treatment option. Our study aimed to assess the influence of prehospital fluid replacement therapy on the post-traumatic course of severely injured patients in a retrospective analysis of matched pairs.
  
  
  METHODS
  The data of 51,425 patients of the Trauma Registry of the German Society for Trauma Surgery were analysed. The following patients were included: 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 (pRBC), systolic blood pressure ≥ 60 mmHg at the accident site. The patients were divided into two groups according to the following matched-pair criteria (low-volume: 0-1500 ml prehospital volume replaced; high-volume: ≥ 1501 ml prehospital volume): intubation at the accident site (yes/no), time from injury to hospital ± 10 min., means of rescue (emergency helicopter, MICU), Abbreviated Injury Scale (body regions), injury year, systolic blood pressure and age (years). All patients were managed by an emergency doctor at the accident site.
  
  
  RESULTS
  A total of 948 patients in each group met the inclusion criteria. Increasing replacement volume was associated with an increased need for transfusion (pRBCs: low-volume: 7 units, high-volume: 8.3 units; p<0.001) and a reduced ability to coagulate (prothrombin ratio (PR): low-volume: 68%, high-volume: 61.5%; p<0.001). Patients in shock (systolic BP<90 mmHg) upon admission to the hospital were equally in both groups (25.6%; p=0.98). Significantly higher lethality was observed in cases of increasing volume (low-volume: 22.7%, high-volume: 27.6%; p<0.01).
  
  
  CONCLUSIONS
  Excessive prehospital fluid replacement leads to an increased mortality rate. The results of this study support the concept of restrained volume replacement in the prehospital treatment of patients with severe trauma.
authors.affiliation: Trauma Surgery Dept., University Hospital Essen, Germany. bjoern.hussmann@uk-essen.de
authors.forename: Bjoern
authors.initials: B
authors.lastname: Hussmann
authors.forename: Rolf
authors.initials: R
authors.lastname: Lefering
authors.forename: Christian
authors.initials: C
authors.lastname: Waydhas
authors.forename: Alexander
authors.initials: A
authors.lastname: Touma
authors.forename: Max D
authors.initials: MD
authors.lastname: Kauther
authors.forename: Steffen
authors.initials: S
authors.lastname: Ruchholtz
authors.forename: Sven
authors.initials: S
authors.lastname: Lendemans
mesh_terms: D015998:Abbreviated Injury Scale; D000328:Adult; D004632:Emergency Medical Services; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects* / Q000379:methods; D005858:Germany / Q000453:epidemiology; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D007440:Intubation / Q000379:methods; D008297:Male; D016555:Matched-Pair Analysis; D009104:Multiple Trauma / Q000150:complications / Q000401:mortality* / Q000628:therapy; D012042:Registries; D012151:Resuscitation / Q000379:methods*; D012189:Retrospective Studies; D018805:Sepsis / Q000401:mortality; D012771:Shock, Hemorrhagic / Q000401:mortality; D013997:Time Factors; D014947:Wounds and Injuries / Q000150:complications / Q000401:mortality* / Q000628:therapy