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Open Access 01-12-2019 | Central Nervous System Trauma | Research article

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

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

Published in: BMC Emergency Medicine | Issue 1/2019

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).

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Title: Enhanced prehospital volume therapy does not lead to improved outcomes in severely injured patients with severe traumatic brain injury
Authors: Bjoern Hussmann
Carsten Schoeneberg
Pascal Jungbluth
Matthias Heuer
Rolf Lefering
Teresa Maek
Frank Hildebrand
Sven Lendemans
Hans-Christoph Pape
Publication date: 01-12-2019
Publisher: BioMed Central
Keywords: Central Nervous System Trauma
Emergency Medicine
Shock
Shock
Published in: BMC Emergency Medicine / Issue 1/2019
Electronic ISSN: 1471-227X
DOI: https://doi.org/10.1186/s12873-019-0221-x

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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