title: Differences between blunt and penetrating trauma after resuscitation with hydroxyethyl starch.
abstract: BACKGROUND
  The purpose of this study was to test the hypothesis that a single bolus of 6% hydroxyethyl starch (HES 450/0.7 in lactated electrolyte injection) during initial resuscitation has a differential effect in blunt and penetrating trauma patients.
  
  
  METHODS
  Consecutive admissions to the trauma service were reviewed. Patients who died within 24 hours were excluded. Multivariate analysis defined individual predictors for the primary outcomes, acute kidney injury (AKI) and mortality within 90 days. Data were expressed as mean ± SD, and significance was assessed at p < 0.05.
  
  
  RESULTS
  There were 1,410 patients (76% male; mean ± SD, age 43 ± 18 years; 68% blunt trauma; mean ± SD Injury Severity Score [ISS] 14 ± 11; AKI, 4.4%; and mortality, 3.4%). HES (0.5-1.5 L) was administered to 216 patients (15.3%). After multiple logistic regression, HES remained a significant independent predictor of AKI after blunt trauma (odds ratio [OR], 2.54; 95% confidence interval [CI], 1.24-5.19; area under the receiver operating characteristic curve [AUROC], 0.809) but not penetrating trauma (OR, 0.90; 95% CI, 0.23-3.60; AUROC, 0.849). In separate logistic regression models, HES was a significant predictor of mortality after blunt trauma (OR, 3.77; 95% CI, 0.91-0.97; AUROC, 0.921) but not penetrating trauma (OR, 0.72; 95% CI, 0.13-3.94; AUROC, 0.904).
  
  
  CONCLUSIONS
  HES is an independent risk factor for AKI and death after blunt, but not penetrating, trauma, which underscores a fundamental difference between these two injury types.
  
  
  METHODS
  Epidemiologic study, level III.
authors.affiliation: From the Divisions of Trauma, Surgical Critical Care, Dewitt-Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Casey J
authors.initials: CJ
authors.lastname: Allen
authors.forename: Evan J
authors.initials: EJ
authors.lastname: Valle
authors.forename: Jassin M
authors.initials: JM
authors.lastname: Jouria
authors.forename: Carl I
authors.initials: CI
authors.lastname: Schulman
authors.forename: Nicholas
authors.initials: N
authors.lastname: Namias
authors.forename: Alan S
authors.initials: AS
authors.lastname: Livingstone
authors.forename: Kenneth G
authors.initials: KG
authors.lastname: Proctor
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D000328:Adult; D005260:Female; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects / Q000627:therapeutic use*; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000009:adverse effects / Q000627:therapeutic use*; D012151:Resuscitation / Q000379:methods*; D012189:Retrospective Studies; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D014950:Wounds, Penetrating / Q000150:complications / Q000188:drug therapy* / Q000401:mortality
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes