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Limit Crystalloid Resuscitation after Traumatic Brain Injury
Patients with traumatic brain injury (TBI) are often resuscitated with crystalloids in the emergency department (ED) to maintain cerebral perfusion. The purpose of this study was to evaluate whether crystalloid resuscitation volume impacts mortality in TBI patients. This was a retrospective study of...
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| Published in: | The American surgeon 2017-12, Vol.83 (12), p.1447-1452 |
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| container_end_page | 1452 |
| container_issue | 12 |
| container_start_page | 1447 |
| container_title | The American surgeon |
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| creator | Ko, Ara Harada, Megan Y. Barmparas, Galinos Smith, Eric J. T. Birch, Kurtis Barnard, Zachary R. Yim, Dorothy A. Ley, Eric J. |
| description | Patients with traumatic brain injury (TBI) are often resuscitated with crystalloids in the emergency department (ED) to maintain cerebral perfusion. The purpose of this study was to evaluate whether crystalloid resuscitation volume impacts mortality in TBI patients. This was a retrospective study of trauma patients with head abbreviated injury scale score ≥2, who received crystalloids during ED resuscitation between 2004 and 2013. Clinical characteristics and volume of crystalloids received in the ED were collected. Patients who received |
| doi_str_mv | 10.1177/000313481708301234 |
| format | article |
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T. ; Birch, Kurtis ; Barnard, Zachary R. ; Yim, Dorothy A. ; Ley, Eric J.</creator><creatorcontrib>Ko, Ara ; Harada, Megan Y. ; Barmparas, Galinos ; Smith, Eric J. T. ; Birch, Kurtis ; Barnard, Zachary R. ; Yim, Dorothy A. ; Ley, Eric J.</creatorcontrib><description>Patients with traumatic brain injury (TBI) are often resuscitated with crystalloids in the emergency department (ED) to maintain cerebral perfusion. The purpose of this study was to evaluate whether crystalloid resuscitation volume impacts mortality in TBI patients. This was a retrospective study of trauma patients with head abbreviated injury scale score ≥2, who received crystalloids during ED resuscitation between 2004 and 2013. Clinical characteristics and volume of crystalloids received in the ED were collected. Patients who received <2 L of crystalloids were categorized as low volume (LOW), whereas those who received ≥2 L were considered high volume (HIGH). Mortality and outcomes were compared. Multivariable regression analysis was used to determine the odds of mortality while controlling for confounders. Over 10 years, 875 patients met inclusion criteria. Overall mortality was 12.5 per cent. Seven hundred and forty-two (85%) were in the LOW cohort and 133 (15%) in the HIGH cohort. Gender and age were similar between the groups. The HIGH cohort had lower admission systolic blood pressure (128 vs 138 mm Hg, P = 0.001), lower Glasgow coma scale score (10 vs 12, P < 0.001), higher head abbreviated injury scale (3.8 vs 3.3, P < 0.001), and higher injury severity score (25 vs 18, P < 0.001). The LOW group had a lower unadjusted mortality (10 vs 26%, P < 0.001). Multivariable analysis adjusting for confounders demonstrated that those resuscitated with ≥2 L of crystalloids had increased odds of mortality (adjusted odds ratio 2.25, P = 0.005). Higher volume crystalloid resuscitation after TBI is associated with increased mortality, thus limited resuscitation for TBI patients may be indicated.</description><identifier>ISSN: 0003-1348</identifier><identifier>EISSN: 1555-9823</identifier><identifier>DOI: 10.1177/000313481708301234</identifier><identifier>PMID: 29336770</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Age ; Blood pressure ; Brain ; Coma ; Emergency medical services ; Fluids ; Gender ; Head injuries ; Injury analysis ; Injury prevention ; Mortality ; Patients ; Perfusion ; Regression analysis ; Resuscitation ; Systematic review ; Trauma ; Trauma centers ; Traumatic brain injury</subject><ispartof>The American surgeon, 2017-12, Vol.83 (12), p.1447-1452</ispartof><rights>2017 Southeastern Surgical Congress</rights><rights>Copyright Southeastern Surgical Congress Dec 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c415t-f812353fefb3bb4c27ce0df709002b2bb440b2833b6ddec4abd9478ae5680b143</citedby><cites>FETCH-LOGICAL-c415t-f812353fefb3bb4c27ce0df709002b2bb440b2833b6ddec4abd9478ae5680b143</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925,79364</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29336770$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ko, Ara</creatorcontrib><creatorcontrib>Harada, Megan Y.</creatorcontrib><creatorcontrib>Barmparas, Galinos</creatorcontrib><creatorcontrib>Smith, Eric J. T.</creatorcontrib><creatorcontrib>Birch, Kurtis</creatorcontrib><creatorcontrib>Barnard, Zachary R.</creatorcontrib><creatorcontrib>Yim, Dorothy A.</creatorcontrib><creatorcontrib>Ley, Eric J.</creatorcontrib><title>Limit Crystalloid Resuscitation after Traumatic Brain Injury</title><title>The American surgeon</title><addtitle>Am Surg</addtitle><description>Patients with traumatic brain injury (TBI) are often resuscitated with crystalloids in the emergency department (ED) to maintain cerebral perfusion. The purpose of this study was to evaluate whether crystalloid resuscitation volume impacts mortality in TBI patients. This was a retrospective study of trauma patients with head abbreviated injury scale score ≥2, who received crystalloids during ED resuscitation between 2004 and 2013. Clinical characteristics and volume of crystalloids received in the ED were collected. Patients who received <2 L of crystalloids were categorized as low volume (LOW), whereas those who received ≥2 L were considered high volume (HIGH). Mortality and outcomes were compared. Multivariable regression analysis was used to determine the odds of mortality while controlling for confounders. Over 10 years, 875 patients met inclusion criteria. Overall mortality was 12.5 per cent. Seven hundred and forty-two (85%) were in the LOW cohort and 133 (15%) in the HIGH cohort. Gender and age were similar between the groups. The HIGH cohort had lower admission systolic blood pressure (128 vs 138 mm Hg, P = 0.001), lower Glasgow coma scale score (10 vs 12, P < 0.001), higher head abbreviated injury scale (3.8 vs 3.3, P < 0.001), and higher injury severity score (25 vs 18, P < 0.001). The LOW group had a lower unadjusted mortality (10 vs 26%, P < 0.001). Multivariable analysis adjusting for confounders demonstrated that those resuscitated with ≥2 L of crystalloids had increased odds of mortality (adjusted odds ratio 2.25, P = 0.005). Higher volume crystalloid resuscitation after TBI is associated with increased mortality, thus limited resuscitation for TBI patients may be indicated.</description><subject>Age</subject><subject>Blood pressure</subject><subject>Brain</subject><subject>Coma</subject><subject>Emergency medical services</subject><subject>Fluids</subject><subject>Gender</subject><subject>Head injuries</subject><subject>Injury analysis</subject><subject>Injury prevention</subject><subject>Mortality</subject><subject>Patients</subject><subject>Perfusion</subject><subject>Regression analysis</subject><subject>Resuscitation</subject><subject>Systematic review</subject><subject>Trauma</subject><subject>Trauma centers</subject><subject>Traumatic brain injury</subject><issn>0003-1348</issn><issn>1555-9823</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><recordid>eNp1kEtLAzEUhYMotj7-gAsZcONmbJ6TBNxo8VEoCFLXQ5LJSMo8apJZ9N-boVVEcXW5l--cezgAXCB4gxDnMwghQYQKxKEgEGFCD8AUMcZyKTA5BNMRyEdiAk5CWKeVFgwdgwmWhBScwym4XbrWxWzutyGqpuldlb3aMATjooqu7zJVR-uzlVdDmw4mu_fKddmiWw9-ewaOatUEe76fp-Dt8WE1f86XL0-L-d0yNxSxmNciZWOktrUmWlODubGwqjmUEGKN04lCjQUhuqgqa6jSlaRcKMsKATWi5BRc73w3vv8YbIhl64KxTaM62w-hRFJIJjCXI3r1C133g-9SukRJxAqGGUwU3lHG9yF4W5cb71rltyWC5dht-bfbJLrcWw-6tdW35KvMBMx2QFDv9sff_y0_AXq7f_k</recordid><startdate>201712</startdate><enddate>201712</enddate><creator>Ko, Ara</creator><creator>Harada, Megan Y.</creator><creator>Barmparas, Galinos</creator><creator>Smith, Eric J. T.</creator><creator>Birch, Kurtis</creator><creator>Barnard, Zachary R.</creator><creator>Yim, Dorothy A.</creator><creator>Ley, Eric J.</creator><general>SAGE Publications</general><general>SAGE PUBLICATIONS, INC</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>4T-</scope><scope>4U-</scope><scope>7QL</scope><scope>7RV</scope><scope>7T7</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M2P</scope><scope>M7N</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>S0X</scope><scope>7X8</scope></search><sort><creationdate>201712</creationdate><title>Limit Crystalloid Resuscitation after Traumatic Brain Injury</title><author>Ko, Ara ; Harada, Megan Y. ; Barmparas, Galinos ; Smith, Eric J. T. ; Birch, Kurtis ; Barnard, Zachary R. ; Yim, Dorothy A. ; Ley, Eric J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c415t-f812353fefb3bb4c27ce0df709002b2bb440b2833b6ddec4abd9478ae5680b143</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Age</topic><topic>Blood pressure</topic><topic>Brain</topic><topic>Coma</topic><topic>Emergency medical services</topic><topic>Fluids</topic><topic>Gender</topic><topic>Head injuries</topic><topic>Injury analysis</topic><topic>Injury prevention</topic><topic>Mortality</topic><topic>Patients</topic><topic>Perfusion</topic><topic>Regression analysis</topic><topic>Resuscitation</topic><topic>Systematic review</topic><topic>Trauma</topic><topic>Trauma centers</topic><topic>Traumatic brain injury</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ko, Ara</creatorcontrib><creatorcontrib>Harada, Megan Y.</creatorcontrib><creatorcontrib>Barmparas, Galinos</creatorcontrib><creatorcontrib>Smith, Eric J. T.</creatorcontrib><creatorcontrib>Birch, Kurtis</creatorcontrib><creatorcontrib>Barnard, Zachary R.</creatorcontrib><creatorcontrib>Yim, Dorothy A.</creatorcontrib><creatorcontrib>Ley, Eric J.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Docstoc</collection><collection>University Readers</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing & Allied Health Database</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest research library</collection><collection>ProQuest Science Journals</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><jtitle>The American surgeon</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ko, Ara</au><au>Harada, Megan Y.</au><au>Barmparas, Galinos</au><au>Smith, Eric J. T.</au><au>Birch, Kurtis</au><au>Barnard, Zachary R.</au><au>Yim, Dorothy A.</au><au>Ley, Eric J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Limit Crystalloid Resuscitation after Traumatic Brain Injury</atitle><jtitle>The American surgeon</jtitle><addtitle>Am Surg</addtitle><date>2017-12</date><risdate>2017</risdate><volume>83</volume><issue>12</issue><spage>1447</spage><epage>1452</epage><pages>1447-1452</pages><issn>0003-1348</issn><eissn>1555-9823</eissn><abstract>Patients with traumatic brain injury (TBI) are often resuscitated with crystalloids in the emergency department (ED) to maintain cerebral perfusion. The purpose of this study was to evaluate whether crystalloid resuscitation volume impacts mortality in TBI patients. This was a retrospective study of trauma patients with head abbreviated injury scale score ≥2, who received crystalloids during ED resuscitation between 2004 and 2013. Clinical characteristics and volume of crystalloids received in the ED were collected. Patients who received <2 L of crystalloids were categorized as low volume (LOW), whereas those who received ≥2 L were considered high volume (HIGH). Mortality and outcomes were compared. Multivariable regression analysis was used to determine the odds of mortality while controlling for confounders. Over 10 years, 875 patients met inclusion criteria. Overall mortality was 12.5 per cent. Seven hundred and forty-two (85%) were in the LOW cohort and 133 (15%) in the HIGH cohort. Gender and age were similar between the groups. The HIGH cohort had lower admission systolic blood pressure (128 vs 138 mm Hg, P = 0.001), lower Glasgow coma scale score (10 vs 12, P < 0.001), higher head abbreviated injury scale (3.8 vs 3.3, P < 0.001), and higher injury severity score (25 vs 18, P < 0.001). The LOW group had a lower unadjusted mortality (10 vs 26%, P < 0.001). Multivariable analysis adjusting for confounders demonstrated that those resuscitated with ≥2 L of crystalloids had increased odds of mortality (adjusted odds ratio 2.25, P = 0.005). Higher volume crystalloid resuscitation after TBI is associated with increased mortality, thus limited resuscitation for TBI patients may be indicated.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>29336770</pmid><doi>10.1177/000313481708301234</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| source | Sage Journals Online |
| subjects | Age Blood pressure Brain Coma Emergency medical services Fluids Gender Head injuries Injury analysis Injury prevention Mortality Patients Perfusion Regression analysis Resuscitation Systematic review Trauma Trauma centers Traumatic brain injury |
| title | Limit Crystalloid Resuscitation after Traumatic Brain Injury |
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