A. Ko1, G. Barmparas1, B. J. Sun1, E. Smith1, M. Y. Harada1, E. Chen1, D. Mehrzadi1, E. J. Ley1 1Cedars-Sinai Medical Center,Division Of Trauma And Critical Care,Los Angeles, CA, USA
Introduction: 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 the mortality of TBI patients.
Methods: This was a retrospective study of trauma patients with head AIS ≥ 2, who received crystalloids during ED resuscitation between January 1, 2004 and December 31, 2013. Demographics, clinical data, and volume of crystalloid received in the ED were collected. Patients who received < 2L of crystalloids were categorized as low volume (LOW) while those who received ≥ 2L were considered high volume (HIGH). Mortality and outcomes were compared and multivariate regression analysis was used to determine independent risk factors for mortality.
Results: Over the 10-year study period, 879 patients met inclusion criteria. Overall mortality was 12.9%. 743 (85%) were in the LOW cohort and 136 (15%) in the HIGH cohort. Gender and mean age were similar between the two groups. The HIGH cohort had lower mean admission SBP (125 vs. 138, p<0.001), lower admission GCS (10 vs. 12, p<0.001), higher head AIS (3.8 vs. 3.3, p<0.001) and higher ISS (26 vs. 18, p<0.001). The LOW group had shorter ICU LOS (5 vs. 7 days, p=0.01), hospital LOS (9 vs. 13 days, p=0.02), ventilator days (1 vs. 3 days, p=0.02) and lower mortality (10% vs. 28%, p<0.001). Multivariate analysis demonstrated that ED resuscitation with ≥ 2L of crystalloid independently predicted higher mortality (AOR 1.85, p=0.035).
Conclusion: Higher volume crystalloid resuscitation after TBI is independently associated with increased mortality. When possible, resuscitation with crystalloids less than two liters for TBI patients is recommended.
