Excessive Crystalloid Use Increases Mortality in Trauma

TOPLINE:

A study has shown that administering ≥ 2 L of crystalloids during the prehospital and emergency department phases of treatment increases the risk for mortality in patients with trauma.

METHODOLOGY:

A retrospective cohort study analyzed 10,707 trauma patients aged 16 years or older (median age, 39 years) with systolic blood pressure 1 from the Israel National Trauma Registry (2013-2022).
Patients were primarily injured in motor vehicle collisions (40.4%) or falls (34.1%); 18.6% patients had penetrating injuries, and 4.4% had isolated traumatic brain injuries.
The primary outcome was in-hospital all-cause mortality.

TAKEAWAY:

Researchers noted a trend towards lower utilization of crystalloids over the study period (P
The overall in-hospital all-cause mortality rate was 7.9%, with a median length of hospital stay of 5.0 days (interquartile range [IQR], 2.0-13.0); for the 3202 (29.9%) patients admitted to the intensive care unit, the median length of stay was 4.0 days (IQR, 2.0-14.0).
Crystalloid volumes ≥ 2 L were significantly associated with higher in-hospital mortality (adjusted odds ratio, 1.47 for 2000-2499 mL and 1.49 for ≥ 2500 mL; both P = .01).
Older age, male sex, lower blood pressure, and more severe injury were associated with higher mortality.

IN PRACTICE:

“Volume replacement with two or more liters of crystalloid during the initial resuscitation of trauma patients, including both prehospital and ED phase of care, is an independent risk factor for in-hospital mortality,” the authors wrote. “[The study] supports the principles of judicious fluid resuscitation in trauma,” they added.

SOURCE:

The study was led by Sharon Goldman, MPH, and Irina Radomislensky, BSc, from the Israel National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel, and was published online on November 21, 2024, in The American Journal of Emergency Medicine.

LIMITATIONS:

The observational nature of the study limited causal inference. The findings may not be generalizable to penetrating trauma or settings with different emergency medicine service protocols. Outcomes like respiratory complications and infections were not evaluated.

DISCLOSURES:

The study received no external funding. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.