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Prehospital Intravenous Fluids May Harm Trauma Patients

Mortality highest in patients with penetrating injuries, hypotension, or severe head injury

MONDAY, Jan. 10 (HealthDay News) -- Trauma patients receiving prehospital intravenous fluid have a higher mortality rate than those who do not, according to a study published online Dec. 20 in the Annals of Surgery.

Elliott R. Haut, M.D., of the Johns Hopkins University School of Medicine in Baltimore, and colleagues investigated mortality in 776,734 trauma patients from the National Trauma Data Bank. They compared outcomes of 49.3 percent of those who received prehospital IV fluids with those who did not. Patient demographics, mechanism of injury, physiologic and anatomic injury severity, and other prehospital procedures were covariates. Subgroup data were analyzed based on mechanism (blunt/penetrating), hypotension, immediate surgery, severe head injury, and injury severity score.

The researchers found that patients who received prehospital IV fluid had significantly higher mortality (4.8 percent) than did those who did not (4.5 percent). Multivariable analysis showed that patients who received IV fluid were more likely to die (Odds Ratio, 1.11). This correlation was noted in almost all trauma patient subsets, but was particularly marked in patients with penetrating injuries, hypotension, severe head injury, and those undergoing immediate surgery.

"The harm associated with prehospital IV fluid administration is significant for victims of trauma. The routine use of prehospital IV fluid administration for all trauma patients should be discouraged," the authors write.

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