title: Benefits of Initial Limited Crystalloid Resuscitation in Severely Injured Trauma Patients at Emergency Department.
abstract: BACKGROUND
  Whether initial limited crystalloid resuscitation (LCR) benefits to all severely injured trauma patients receiving blood transfusions at emergency department (ED) is uncertain. We aimed to determine the role of LCR and its associations with packed red blood cell (PRBC) transfusion during initial resuscitation.
  
  
  METHODS
  Trauma patients receiving blood transfusions were reviewed from 2004 to 2013. Patients with LCR (L group, defined as < 2,000 mL) and excessive crystalloid resuscitation (E group, defined as ≥ 2,000 mL) were compared separately in terms of basic demographic, clinical variables, and hospital outcomes. Logistic regression, R-square (R(2)), and Spearman rho correlation were used for analysis.
  
  
  RESULTS
  A total of 633 patients were included. The mortality was 51% in L group and 45% in E group (P = 0.11). No statistically significant difference was found in terms of basic demographics, vital signs upon arrival at ED, or injury severity between the groups. The volume of blood transfused strongly correlated with the volume of crystalloid infused in E group (R(2) = 0.955). Crystalloid to PRBC (C/PRBC) ratio was 0.8 in L group and 1.3 in E group (P < 0.01). The correlations between C/PRBC and ED versus ICU versus hospital length of stay (LOS) via Spearman rho were 0.25, 0.22, and 0.22, respectively.
  
  
  CONCLUSIONS
  Similar outcomes were observed in trauma patients receiving blood transfusions regardless of the crystalloid infusion volume. More crystalloid infusions were associated with more blood transfusions. The C/PRBC did not demonstrate predictive value regarding mortality but might predict LOS in severely injured trauma patients.
authors.affiliation: Department of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Robinson
authors.affiliation: Department of Surgery, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
authors.forename: Jessica Laureano
authors.initials: JL
authors.lastname: Phillips
authors.affiliation: Department of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Kirk
authors.affiliation: Department of Surgery, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
authors.forename: Therese M
authors.initials: TM
authors.lastname: Duane
authors.affiliation: Department of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
authors.forename: Johnbosco
authors.initials: J
authors.lastname: Umejiego
authors.affiliation: Department of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
authors.forename: Melanie
authors.initials: M
authors.lastname: Stanzer
authors.affiliation: Department of Surgery, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
authors.forename: Mackenzie B
authors.initials: MB
authors.lastname: Campbell-Furtick
authors.affiliation: Department of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
authors.forename: Nestor R
authors.initials: NR
authors.lastname: Zenarosa
keywords: Crystalloid; Emergency department; Packed red blood cell; Resuscitation; Trauma