On-Scene IV Fluids for Trauma Patients Cause More Harm Than Good

Severely injured patients who are given intravenous (IV) fluids by paramedics before transport for hospitalization are significantly more likely to die than similarly injured patients who do not, according to a new study.

Researchers at Johns Hopkins University (JHU; Baltimore, MD, USA) conducted a retrospective cohort study of 776,734 trauma patients registered in the American College of Surgeons (ACS) National Trauma Data Bank between 2001 and 2005, comparing patients with or without prehospital IV fluid administration. Patient demographics, mechanism, physiologic and anatomic injury severity, and other prehospital procedures were used as covariates. An additional subset analysis was performed based on wound mechanism, hypotension, immediate surgery, severe head injury, and injury severity score. The patients were primarily male, white and under the age of 40; about 50% were given IV fluids at the scene.

The researchers found that overall mortality was 4.6%. Patients who received prehospital IV fluids were 11% more likely to die than those who did not. The findings were especially marked in people who were shot or stabbed (25% more likely to die), had severe head injuries (35% more likely), and who received emergency surgery once hospitalized (35% more likely). The study was published in the February 2011 issue of Annals of Surgery.

"Giving IV fluids to patients before they go to the hospital can delay transport,” said lead author Elliott Haut, MD, an associate professor of surgery, anesthesiology, and critical care medicine at JHU. "Our study suggests it may be better to get patients to the hospital faster. Starting fluids takes time and the IV fluids may cause harm on top of the timing issue.”

Emergency medical personnel are often required to perform a variety of interventions before transporting patients to the hospital, such as mandatory immobilization with a cervical collar before transport. In some regions, IV fluids must always be given, and some types of patients are required to be intubated at the scene. Each step takes precious time, and in some cases, the time it takes to place an IV may exceed the length of the trip to the emergency room.

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