Use of prehospital fluids in hypotensive blunt trauma patients.

OBJECTIVE: To compare the outcomes of blunt trauma victims with systolic blood pressure < or = 90 mm Hg who received prehospital fluids with the outcomes of those who did not receive prehospital fluids.

METHODS: This matched-pairs case-control study used records of blunt trauma patients with scene systolic blood pressure < or = 90 mm Hg obtained from the Pennsylvania Trauma Systems Foundation. Patients who received > 500 mL prehospital fluids (n = 75) were matched by Injury Severity Score (ISS) and systolic blood pressure on scene with those who did not receive any prehospital fluids (n = 75). Outcomes compared included change in systolic blood pressure, survival to discharge, and length of hospital stay.

RESULTS: Those who received fluids were more likely to have an increase in systolic blood pressure at arrival to the emergency department [odds ratio for fluid use = 2.41; 95% confidence interval (95% CI) = 1.02, 5.73; p = 0.046]. There was no significant difference in survival to discharge (odds ratio for fluid use = 1.02; 95% CI = 0.40, 2.60; p = 0.969). There was no significant difference in length of hospital stay: 5.4 days (SD = 2.8) for those with fluids; 5.2 days (SD = 2.8) for those with no fluids; difference = 0.2 days; 95% CI = -1.6, 1.8; p = 0.870.

CONCLUSIONS: This study suggests that prehospital fluid resuscitation of blunt injured trauma patients with systolic blood pressure < or = 90 increases systolic blood pressure but has no effect on survival or length of hospital stay.