Prehospital intravenous (IV) fluid administration for trauma patients is as frequent and widespread as it is controversial.
The once emphasized importance of fluid resuscitation to hemodynamically stabilize trauma patients is now being questioned with indications that routine use may be directly related to higher mortality in certain subsets of patients.
This five-year retrospective cohort study of 776 734 patients from a National Trauma Data Bank grouped together patients who actually received IV fluids with those who had IV cannula placement only and referred to these patients as having had ‘prehospital IV’.
This group was compared to trauma patients who were not cannulated and did not receive IV fluids. The primary outcome measure in both groups was in-hospital mortality.
Multiple logistic regression analysis was used acknowledging patient variables such as race, age, gender, mechanism of injury, Injury Severity Score, Glasgow Coma Scale Score.
In addition, various subgroups of trauma patients were identified, for example, normotensive and hypotensive patients, gunshot wound, patients with severe head injury, and penetrating and blunt trauma patients.
In total, 49.3% of the 776 734 patients received prehospital IV with the overall mortality being 4.6%. Patients in nearly all subsets receiving prehospital IV placement were significantly more likely to die (odds ratio 1.11, 95% CI 1.06–1.17).
Limitations associated with retrospective studies are evident in this study but the findings strongly indicate a need for a more balanced approach to prehospital trauma fluid administration.
