title: Prehospital volume therapy as an independent risk factor after trauma.
abstract: BACKGROUND
  Prehospital volume therapy remains widely used after trauma, while evidence regarding its disadvantages is growing. The primary objective of this study was to investigate the volume administered in a prehospital setting as an independent risk factor for mortality.
  
  
  METHODS
  Patients who met the following criteria were analyzed retrospectively: Injury Severity Score=16, primary admission (between 2002 and 2010), and age=16 years. The following data had to be available: volume administered (including packed red cells), blood pressure, Glasgow Coma Scale, therapeutic measures, and laboratory results. Following a univariate analysis, independent risk factors for mortality after trauma were investigated using a multivariate regression analysis.
  
  
  RESULTS
  A collective of 7,641 patients met the inclusion criteria, showing that increasing volumes administered in a prehospital setting were an independent risk factor for mortality (odds ratio: 1.34). This tendency was even more pronounced in patients without severe traumatic brain injury (TBI) (odds ratio: 2.71), while the opposite tendency was observed in patients with TBI.
  
  
  CONCLUSIONS
  Prehospital volume therapy in patients without severe TBI represents an independent risk factor for mortality. In such cases, respiratory and circulatory conditions should be stabilized during permissive hypotension, and patient transfer should not be delayed.
authors.affiliation: Trauma Surgery Department, Alfried Krupp Hospital Essen, Alfried-Krupp-Straße 21, 45131 Essen, Germany.
authors.forename: Bjoern
authors.identifier: 0000-0001-8333-6367
authors.initials: B
authors.lastname: Hussmann
authors.affiliation: Surgery Department, Philippusstift Essen, Huelsmannstraße 17, 45355 Essen, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Heuer
authors.affiliation: Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Ostmerheimer Straße 200, 51109 Cologne, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Lefering
authors.affiliation: Trauma Surgery Department, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Touma
authors.affiliation: Trauma Surgery Department, Alfried Krupp Hospital Essen, Alfried-Krupp-Straße 21, 45131 Essen, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Schoeneberg
authors.affiliation: Trauma Surgery Department, Alfried Krupp Hospital Essen, Alfried-Krupp-Straße 21, 45131 Essen, Germany.
authors.forename: Judith
authors.initials: J
authors.lastname: Keitel
authors.affiliation: Trauma Surgery Department, Alfried Krupp Hospital Essen, Alfried-Krupp-Straße 21, 45131 Essen, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Lendemans
mesh_terms: D000328:Adult; D017677:Age Distribution; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate; D014947:Wounds and Injuries / Q000401:mortality* / Q000628:therapy*