Enhanced prehospital volume therapy does not lead to improved outcomes in severely injured patients with severe traumatic brain injury View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2019-12

AUTHORS

Bjoern Hussmann, Carsten Schoeneberg, Pascal Jungbluth, Matthias Heuer, Rolf Lefering, Teresa Maek, Frank Hildebrand, Sven Lendemans, Hans-Christoph Pape

ABSTRACT

BACKGROUND: Whether enhanced prehospital volume therapy leads to outcome improvements in severely injured patients with severe traumatic brain injury (TBI) remains controversial. The aim of this study was to investigate the influence of prehospital volume therapy on the clinical course of severely injured patients with severe TBI. METHODS: Data for 122,672 patients from TraumaRegister DGU® (TR-DGU) was analyzed. Inclusion criteria were defined as follows: Injury Severety Score (ISS) ≥ 16, primary admission, age ≥ 16 years, Abbreviated Injury Scale (AIS) head ≥3, administration of at least one unit of packed red blood cells (pRBCs), and available volume and blood pressure data. Stratification based on the following matched-pair criteria was performed: group 1: prehospital volumes of 0-1000 ml; group 2: prehospital volumes of ≥1501 ml; AIS head (3, 4, 5 + 6 and higher than for other body regions); age (16-54, 55-69, ≥ 70 years); gender; prehospital intubation (yes/no); emergency treatment time +/- 30 min.; rescue resources (rescue helicopter, emergency ambulance); blood pressure (20-60, 61-90, ≥ 91 mmHg); year of accident (2002-2005, 2006-2009, 2010-2012); AIS thorax, abdomen, and extremities plus pelvis. RESULTS: A total of 169 patients per group fulfilled the inclusion criteria. Increasing volume administration was associated with reduced coagulation capability and reduced hemoglobin (Hb) levels (prothrombin ratio: group 1: 68%, group 2: 63.7%; p ≤ 0.04; Hb: group 1: 11.2 mg/dl, group 2: 10.2 mg/dl; p ≤ 0.001). It was not possible to show a significant reduction in the mortality rate with increasing volumes (group 1: 45.6, group 2: 45.6; p = 1). CONCLUSIONS: The data presented in this study demonstrates that prehospital volume administration of more than 1500 ml does not improve severely injured patients with severe traumatic brain injury (TBI). More... »

PAGES

13

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s12873-019-0221-x

DOI

http://dx.doi.org/10.1186/s12873-019-0221-x

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1111593814

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/30674281


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    "description": "BACKGROUND: Whether enhanced prehospital volume therapy leads to outcome improvements in severely injured patients with severe traumatic brain injury (TBI) remains controversial. The aim of this study was to investigate the influence of prehospital volume therapy on the clinical course of severely injured patients with severe TBI.\nMETHODS: Data for 122,672 patients from TraumaRegister DGU\u00ae (TR-DGU) was analyzed. Inclusion criteria were defined as follows: Injury Severety Score (ISS)\u2009\u2265\u200916, primary admission, age\u2009\u2265\u200916\u2009years, Abbreviated Injury Scale (AIS) head \u22653, administration of at least one unit of packed red blood cells (pRBCs), and available volume and blood pressure data. Stratification based on the following matched-pair criteria was performed: group 1: prehospital volumes of 0-1000\u2009ml; group 2: prehospital volumes of \u22651501\u2009ml; AIS head (3, 4, 5\u2009+\u20096 and higher than for other body regions); age (16-54, 55-69, \u2265 70\u2009years); gender; prehospital intubation (yes/no); emergency treatment time +/-\u200930\u2009min.; rescue resources (rescue helicopter, emergency ambulance); blood pressure (20-60, 61-90, \u2265 91\u2009mmHg); year of accident (2002-2005, 2006-2009, 2010-2012); AIS thorax, abdomen, and extremities plus pelvis.\nRESULTS: A total of 169 patients per group fulfilled the inclusion criteria. Increasing volume administration was associated with reduced coagulation capability and reduced hemoglobin (Hb) levels (prothrombin ratio: group 1: 68%, group 2: 63.7%; p\u2009\u2264\u20090.04; Hb: group 1: 11.2\u2009mg/dl, group 2: 10.2\u2009mg/dl; p\u2009\u2264\u20090.001). It was not possible to show a significant reduction in the mortality rate with increasing volumes (group 1: 45.6, group 2: 45.6; p\u2009=\u20091).\nCONCLUSIONS: The data presented in this study demonstrates that prehospital volume administration of more than 1500\u2009ml does not improve severely injured patients with severe traumatic brain injury (TBI).", 
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