Masafumi Suga, MB
Kobe City Medical Center General Hospital
Kobe, Japan
Disclosure information not submitted.
Shinichi Ijuin
M.D.
Hyogo Emergency Medical Center, United States
Disclosure information not submitted.
Shota Kikuta
M.D.
Hyogo Emergency Medical Hospital, United States
Disclosure information not submitted.
Takeshi Nishimura
M.D.
Hyogo medical emergency hospital, United States
Disclosure information not submitted.
Satoshi Ishihara
M.D.
Hyogo Emergency Medical Center, United States
Disclosure information not submitted.
Shinichi Nakayama
MD
Hyogo Emergency Medical Center, United States
Disclosure information not submitted.
Title: Association between Prehospital Fluid Therapy and Fibrinogen Level in Trauma Patients
Objectives:
The fluid therapy for trauma patients, especially a prehospital fluid, has been reported that it increases the mortality rate. Although, it is believed that dilutional coagulopathy is one of the causes, the detail data including how much fluid volume affect is still unclear. We hypothesized that increased prehospital fluid volume adversely affect the coagulation system. The purpose of this study was to evaluate the association between prehospital fluid volume and fibrinogen levels at admission in trauma patients.
Methods:
A retrospective analysis was performed in a single center of trauma patients, who admitted to our hospital by ambulance with physician between May 2007 and December 2020. The primary outcome was the presence of coagulopathy, defined as fibrinogen levels at admission < 150 mg/dl. Patients were divided into two groups, higher volume group and lower volume group, according to using interquartile range (IQR) of the amount of prehospital fluid. Multivariable logistic regression analysis was performed. Then we used propensity score methods adjusting for patient characteristics.
Results:
During the study period, a total of 922 patients were included. The median age was 45 years [IQR, 28–64] and 694 patients (75%) were men. The median injury severity score was 17 [IQR, 9–29] and the median prehospital fluid was 150 ml [IQR, 100–300]. Patients were divided into two groups using IQR of prehospital fluid volume, prehospital fluid >300 ml was defined as higher volume group (n=181) and prehospital fluid ≤300 ml was defined as lower volume group (n=741). Regarding the primary outcome, the presence of coagulopathy was 21.5% in the higher volume group, and 8.4% in the lower volume group (P< 0.001). Multivariate analysis showed that higher volume group was significantly associated with the coagulopathy [odds ratio 2.39; 95% confidence interval 1.45-3.92, p< 0.001]. After propensity score matching, 142 patients were assigned to each group. The presence of coagulopathy was 23.4% in higher volume group, and 13.4% in lower volume group (P=0.011).
Conclusion:
Prehospital higher fluid volume was associated with coagulopathy in trauma patients.