title: Prehospital fluid management of abdominal organ trauma patients--a matched pair analysis.
abstract: OBJECTIVE
  Severe bleeding after trauma frequently leads to a poor outcome. Prehospital fluid replacement therapy is considered an important primary treatment option. We conducted a retrospective matched pair analysis to assess the influence of prehospital fluid replacement volume on the clinical course of patients with solid abdominal organ trauma.
  
  
  METHODS
  Data were analyzed from 51,425 patients in TraumaRegister DGU® of the German Trauma Society. Inclusion criteria were as follows: 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 (pRBCs), and systolic blood pressure ≥ 20 mmHg at the accident site. The patients were divided into "low-volume" (0-1000 ml) and "high-volume" (≥ 1,500 ml) groups according to the matched pair criteria. In each group, 68 patients met the inclusion criteria.
  
  
  RESULTS
  Higher volume in fluid replacement was associated with increased need for transfusion (pRBCs: low-volume: 7.71 units, high-volume: 9.16 units; p = 0.074) and with by trend reduced clotting ability (prothrombin time: low-volume: 71.47 %, high-volume: 66.47 %; p = 0.27). The percentage of patients in shock (systolic blood pressure <90 mmHg) upon admission was equal in the two groups (25.0 %; p = 1). The mortality rate was discretely higher in the high-volume group (low-volume: 11.8 %, high-volume: 19.1 %; p = 0.089).
  
  
  CONCLUSIONS
  Excessive prehospital fluid replacement is able to lead in an increased mortality rate in patients with solid abdominal organ injury. Our results support the concept of restrained fluid replacement in the preclinical treatment of severe trauma patients.
authors: Department of General and Visceral Surgery, Center of Minimal Invasive Surgery, Catholic Hospital of Essen, Hülsmannstrasse 17, 45355, Essen, Germany, m.heuer@kk-essen.de.
authors: Matthias
authors: M
authors: Heuer
authors: Björn
authors: B
authors: Hussmann
authors: Rolf
authors: R
authors: Lefering
authors: Gernot M
authors: GM
authors: Kaiser
authors: Christoph
authors: C
authors: Eicker
authors: Olaf
authors: O
authors: Guckelberger
authors: Sven
authors: S
authors: Lendemans
mesh_terms: D000007:Abdominal Injuries / Q000601:surgery*; D000328:Adult; D001803:Blood Transfusion / Q000706:statistics & numerical data; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects*; D005858:Germany; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D016555:Matched-Pair Analysis; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D011517:Prothrombin Time; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012769:Shock / Q000150:complications / Q000628:therapy; D016896:Treatment Outcome