Association between prehospital fluid resuscitation with crystalloids and outcome of trauma patients in Asia by a cross-national multicenter cohort study
Chih‐Wei Sung, Jen‐Tang Sun, Edward Pei‐Chuan Huang, Sang Do Shin, Kyoung Jun Song, Ki Jeong Hong, Sabariah Faizah Jamaluddin, Do Ngoc Son, Ming‐Ju Hsieh, Matthew Huei‐Ming, Li-Min Hsu, Wen‐Chu Chiang, Ramana Rao, George P. Abraham, T. Ramakrishnan, Sabariah Faiwah Jamaluddin, Mohd Amin Bin Mohidin, Al-Hilmi Saim, Lim Chee Kean, Cecilia Anthonysamy, Shah Jahan Din Mohd Yssof, Kang Wen Ji, Cheah Phee Kheng, Shamila bt Mohamad Ali, P. Kasi Ramanathan, Chia Boon Yang, Hon Woei Chia, Hafidahwati Binti Hamad, Samsu Ambia Ismail, Wan Rasydan B. Wan Abdullah, Hideharu Tanaka, Akio Kimura, Bernadett Velasco, Carlos D. Gundran, Pauline Convocar, Nerissa G. Sabarre, Patrick Joseph Tiglao, Ki Jeong Hong, Kyoung Jun Song, Joo Jeong, Sung Woo Moon, Joo-yeong Kim, Won Chul Cha, Seung Chul Lee, Jae Yun Ahn, Kang Hyeon Lee, Seok Ran Yeom, Hyeon Ho Ryu, Su Jin Kim, Sang Chul Kim, Rey‐Heng Hu, Jen Tang Sun, Ruei-Fang Wang, Shang-Lin Hsieh, Wei‐Fong Kao, Sattha Riyapan, Parinya Tianwibool, Phudit Buaprasert, Osaree Akaraborworn, Omer Ahmed Al Sakaf, Saleh Fares, Le Bao Huy, Do Ngoc Son, Nguyen Van Dai
Abstract
Abstract Prehospital fluid resuscitation with crystalloids in patients following trauma remain controversial. This study aimed to investigate the association between prehospital fluid resuscitation and outcomes of trauma patients in Asia. We conducted a retrospective cohort study of trauma patients between 2016 and 2018 using data from the Pan-Asia Trauma Outcomes Study (PATOS) database. Prehospital fluid resuscitation was defined as any administration of intravenous crystalloid fluid on the ambulance before arrival to hospitals. The outcomes were in-hospital mortality and poor functional outcomes, defined as Modified Rankin Scale ≥ 4. Propensity score matching (PSM) was used to equalize potential prognostic factors in both groups. This study included 31,735 patients from six countries in Asia, and 4318 (13.6%) patients had ever received prehospital fluid resuscitation. The patients receiving prehospital fluid resuscitation had a higher risk of in-hospital mortality, with an adjusted odds ratio (aOR) of 2.02, 95% confidence interval (CI) 1.32–3.10, p = 0.001 in PSM analysis. Prehospital fluid resuscitation was also associated with poor functional outcomes, with an OR 1.73, 95% CI: 1.48–2.03, p < 0.001 in PSM analysis. Prehospital fluid resuscitation in patients with major trauma (injury severity score ≥ 16) presented a higher risk of poor functional outcomes (aOR = 2.65, 95% CI: 1.89–3.73 in PSM analysis, p interaction = 0.006) via subgroup analysis. Prehospital fluid resuscitation of trauma patients is associated with higher in-hospital mortality and poor functional outcomes in the subgroup in countries studied.