title: Is Hydroxyethyl Starch Safe in Penetrating Trauma Patients?
abstract: For logistic reasons, a bolus of 6% hydroxyethyl starch (HES 450/0.7 in lactated electrolyte injection) is recommended for battlefield resuscitation even though it has risks of mortality and acute kidney injury (AKI) in certain patient populations. The purpose of this study was to test the hypothesis that victims of penetrating trauma have no increased risks of AKI and/or death when receiving a single bolus of HES during initial fluid resuscitation.
  
  
  
  816 consecutive admissions with penetrating trauma were reviewed. Patients who died within 24 hours were excluded. Propensity scores and a 1:1 fixed ratio nearest neighbor matching were used to compare those who received HES to those who did not. Data were expressed as mean ± SD and significance was assessed at p < 0.05.
  
  
  
  The cohort was 88% male, age 35 ± 14 years, injury severity score of 10 ± 10, with a 3.8% rate of AKI, and 3.2% rate of mortality. HES was administered to 121 (14.8%) patients. In HES and no HES propensity matched groups, the rate of AKI was 3.8% vs. 4.8% (p = 0.749) and the 90-day mortality rate was 3.8% vs. 4.8% (p = 0.749).
  
  
  
  An increased risk of mortality or AKI was not observed in penetrating trauma patients who were resuscitated with low volume HES.
authors.affiliation: Divisions of Trauma and Surgical Critical Care, DeWitt Daughtry Department of Surgery, Ryder Trauma Center, University of Miami School of Medicine, 1800 Northwest 10th Avenue, Miami, FL 33136.
authors.forename: Casey J
authors.initials: CJ
authors.lastname: Allen
authors.affiliation: Divisions of Trauma and Surgical Critical Care, DeWitt Daughtry Department of Surgery, Ryder Trauma Center, University of Miami School of Medicine, 1800 Northwest 10th Avenue, Miami, FL 33136.
authors.forename: Xiomara D
authors.initials: XD
authors.lastname: Ruiz
authors.affiliation: Divisions of Trauma and Surgical Critical Care, DeWitt Daughtry Department of Surgery, Ryder Trauma Center, University of Miami School of Medicine, 1800 Northwest 10th Avenue, Miami, FL 33136.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Meizoso
authors.affiliation: Divisions of Trauma and Surgical Critical Care, DeWitt Daughtry Department of Surgery, Ryder Trauma Center, University of Miami School of Medicine, 1800 Northwest 10th Avenue, Miami, FL 33136.
authors.forename: Juliet J
authors.initials: JJ
authors.lastname: Ray
authors.affiliation: Divisions of Trauma and Surgical Critical Care, DeWitt Daughtry Department of Surgery, Ryder Trauma Center, University of Miami School of Medicine, 1800 Northwest 10th Avenue, Miami, FL 33136.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Livingstone
authors.affiliation: Divisions of Trauma and Surgical Critical Care, DeWitt Daughtry Department of Surgery, Ryder Trauma Center, University of Miami School of Medicine, 1800 Northwest 10th Avenue, Miami, FL 33136.
authors.forename: Carl I
authors.initials: CI
authors.lastname: Schulman
authors.affiliation: Divisions of Trauma and Surgical Critical Care, DeWitt Daughtry Department of Surgery, Ryder Trauma Center, University of Miami School of Medicine, 1800 Northwest 10th Avenue, Miami, FL 33136.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Namias
authors.affiliation: Divisions of Trauma and Surgical Critical Care, DeWitt Daughtry Department of Surgery, Ryder Trauma Center, University of Miami School of Medicine, 1800 Northwest 10th Avenue, Miami, FL 33136.
authors.forename: Kenneth G
authors.initials: KG
authors.lastname: Proctor
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology*; D000328:Adult; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology; D005260:Female; D005440:Fluid Therapy / Q000379:methods / Q000401:mortality; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects* / Q000494:pharmacology* / Q000627:therapeutic use; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D057216:Propensity Score; D012151:Resuscitation / Q000379:methods*; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000188:drug therapy / Q000401:mortality; D014950:Wounds, Penetrating / Q000188:drug therapy* / Q000401:mortality
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes