PRE-HOSPITAL FLUID RESUSCITATION IS ASSOCIATED WITH TRAUMA-ASSOCIATED COAGULOPATHY IN PATIENTS WITH SEVERE TRAUMA

Abstract

   [Background] There have been various discussion on prehospital fluid resuscitation (PFR) for severe trauma patients. We conducted multi–center observational study on traumatic coagulopathy, and aimed to clarify the relationship between PFR and 3 end points (28–day survival rate ; massive transfusion≥10U/24hr ; and trauma–associated coagulopathy (TAC) : PT–INR≥1.2) in this study. [Patients and methods] Retrospectively collected 796 trauma patients of ISS≥16 and age≥18, in the Japanese Observational Study of Coagulation and Thrombolysis in Early Trauma (J–OCTET) data, were divided into two groups according to whether PFR was done or not. We evaluated the relationship between PFR and the 3 end points using logistic regression analysis, followed by subgroup analysis (age, gender, presence of traumatic brain injury (TBI), and hemostatic treatment including surgery and interventional radiology) was performed. [Results] No difference was observed between PFR (n=85) and non–PFR group (n=711) regarding age, gender, 28–day survival, rate of massive transfusion, and hemostatic intervention. In contrast, ISS and PT–INR were significantly higher in PFR group. Although PFR didn't affect 28 days survival and massive transfusion rate, PFR and ISS were independent risk factors for TAC (odds ratio 1.906, 95% confidence interval 1.10–3.30, P=0.021 ; 1.08, 1.06–1.10, P<0.01, respectively). Subgroup analysis revealed that PFR was an independent risk factor for TAC in the patients under 65, associated with TBI, and requiring hemostatic intervention. [Conclusion] In trauma patients with ISS≥16, PFR may not related to 28 days survival and massive transfusion rate. However, PFR may cause coagulopathy, especially those young, having TBI, requiring hemostatic intervention. Further study is needed to understand the role of PFR for severely traumatized patients.