Trends in pre-hospital volume resuscitation of blunt trauma patients: a 15-year analysis of the British (TARN) and German (TraumaRegister DGU®) National Registries

M F Bath; J Schloer; J Strobel; W Rea; R Lefering; M Maegele; H De'Ath; Z B Perkins

doi:10.1186/s13054-024-04854-x

Trends in pre-hospital volume resuscitation of blunt trauma patients: a 15-year analysis of the British (TARN) and German (TraumaRegister DGU®) National Registries

Crit Care. 2024 Mar 15;28(1):81. doi: 10.1186/s13054-024-04854-x.

Authors

M F Bath^#^{1

2}, J Schloer^#^{1

3}, J Strobel^{4

5}, W Rea¹, R Lefering⁶, M Maegele⁶, H De'Ath¹, Z B Perkins^{7

8}

Affiliations

¹ Centre for Trauma Sciences, Queen Mary, University of London, London, UK.
² Health Systems Design Group, Department of Engineering, University of Cambridge, Cambridge, UK.
³ Department of Emergency Medicine, Klinikum St. Marien Amberg, Amberg, Germany.
⁴ London's Air Ambulance, London, UK.
⁵ Berufsfeuerwehr Hamburg, Emergency Medical Services, Hamburg, Germany.
⁶ Institute for Research in Operative Medicine, Cologne Merheim Medical Center, University of Witten/Herdecke, Cologne, Germany.
⁷ Centre for Trauma Sciences, Queen Mary, University of London, London, UK. z.perkins@qmul.ac.uk.
⁸ London's Air Ambulance, London, UK. z.perkins@qmul.ac.uk.

^# Contributed equally.

Abstract

Introduction: Fluid resuscitation has long been a cornerstone of pre-hospital trauma care, yet its optimal approach remains undetermined. Although a liberal approach to fluid resuscitation has been linked with increased complications, the potential survival benefits of a restrictive approach in blunt trauma patients have not been definitively established. Consequently, equipoise persists regarding the optimal fluid resuscitation strategy in this population.

Methods: We analysed data from the two largest European trauma registries, the UK Trauma Audit and Research Network (TARN) and the German TraumaRegister DGU® (TR-DGU), between 2004 and 2018. All adult blunt trauma patients with an Injury Severity Score > 15 were included. We examined annual trends in pre-hospital fluid resuscitation, admission coagulation function, and mortality rates.

Results: Over the 15-year study period, data from 68,510 patients in the TARN cohort and 82,551 patients in the TR-DGU cohort were analysed. In the TARN cohort, 3.4% patients received pre-hospital crystalloid fluids, with a median volume of 25 ml (20-36 ml) administered. Conversely, in the TR-DGU cohort, 91.1% patients received pre-hospital crystalloid fluids, with a median volume of 756 ml (750-912 ml) administered. Notably, both cohorts demonstrated a consistent year-on-year decrease in the volume of pre-hospital fluid administered, accompanied by improvements in admission coagulation function and reduced mortality rates.

Conclusion: Considerable variability exists in pre-hospital fluid resuscitation strategies for blunt trauma patients. Our data suggest a trend towards reduced pre-hospital fluid administration over time. This trend appears to be associated with improved coagulation function and decreased mortality rates. However, we acknowledge that these outcomes are influenced by multiple factors, including other improvements in pre-hospital care over time. Future research should aim to identify which trauma populations may benefit, be harmed, or remain unaffected by different pre-hospital fluid resuscitation strategies.

Keywords: Crystalloids; Fluids; Outcomes; Resuscitation; Trauma.

MeSH terms

Adult
Crystalloid Solutions
Germany / epidemiology
Hospitals
Humans
Injury Severity Score
Multiple Trauma* / complications
Registries
Retrospective Studies
Wounds, Nonpenetrating* / therapy

Substances

Crystalloid Solutions