title: Injured children are resistant to the adverse effects of early high volume crystalloid resuscitation.
abstract: BACKGROUND
  Excessive crystalloid resuscitation of blunt injured adults is deleterious. We hypothesize that children, unlike adults, are resistant to the adverse effects of high volume resuscitation.
  
  
  METHODS
  We reviewed the trauma databases at two level-one trauma centers, including all children age 4-16years admitted following blunt trauma with an injury severity score (ISS) ≥15 to determine the relationship between crystalloid volume received and clinical outcomes.
  
  
  RESULTS
  A total of 384 children were included. After controlling for age, sex, AIS head, ISS, GCS on presentation, hemoglobin, blood transfusion, and surgical procedures in the first 24hours, crystalloid volume greater than 60ml/kg in the first 24hours was associated with increased length of stay (LOS) and need for mechanical ventilation. On univariate analysis, initial crystalloid volume of >60ml/kg was associated with anemia and thrombocytopenia. Volume of resuscitation was not associated with ARDS, ACS, MOF, urinary tract infection, or blood stream infection. However, these complications were exceedingly rare, with no children developing MOF.
  
  
  CONCLUSIONS
  Excessive crystalloid resuscitation was associated with increased hospital LOS and need for mechanical ventilation. Increased rates of other complications including ARDS, ACS, and MOF were not observed. Injured children appear relatively resistant to some of the adverse effects of early high volume fluid resuscitation.
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO USA. Electronic address: shannon.acker@ucdenver.edu.
authors.forename: Shannon N
authors.initials: SN
authors.lastname: Acker
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO USA. Electronic address: James.ross@ucdenver.edu.
authors.forename: James T
authors.initials: JT
authors.lastname: Ross
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO USA. Electronic address: david.partrick@childrenscolorado.org.
authors.forename: David A
authors.initials: DA
authors.lastname: Partrick
authors.affiliation: Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO USA. Electronic address: peter.dewitt@ucdenver.edu.
authors.forename: Peter
authors.initials: P
authors.lastname: DeWitt
authors.affiliation: Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO USA; Department of Surgery, Denver Health Medical Center, Denver, CO USA. Electronic address: denis.bensard@dhha.org.
authors.forename: Denis D
authors.initials: DD
authors.lastname: Bensard
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D000077324:Crystalloid Solutions; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects; D006801:Humans; D015601:Injury Severity Score; D007552:Isotonic Solutions / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D015532:Rehydration Solutions / Q000009:adverse effects*; D012121:Respiration, Artificial; D014949:Wounds, Nonpenetrating / Q000628:therapy*
chemical_list: D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D015532:Rehydration Solutions
keywords: Blunt trauma; Children; Crystalloid; Resuscitation