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MacArthur, Taleen A.; Vogel, Adam M.; Glasgow, Amy E.; Moody, Suzanne; Kotagal, Meera; Williams, Regan F.; Kayton, Mark L.; Alberto, Emily C.; Burd, Randall S.; Schroeppel, Thomas J.; Baerg, Joanne E.; Munoz, Amanda; Rothstein, William B.; Boomer, Laura A.; Campion, Eric M.; Robinson, Caitlin; Nygaard, Rachel M.; Richardson, Chad J.; Garcia, Denise I.; Streck, Christian J.; Gaffley, Michaela; Petty, John K.; Ryan, Mark; Pandya, Samir; [...]

Crystalloid volume is associated with short-term morbidity in children with severe traumatic brain injury: An Eastern Association for the Surgery of Trauma multicenter trial post hoc analysis

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  • Medientyp: E-Artikel
  • Titel: Crystalloid volume is associated with short-term morbidity in children with severe traumatic brain injury: An Eastern Association for the Surgery of Trauma multicenter trial post hoc analysis
  • Beteiligte: MacArthur, Taleen A.; Vogel, Adam M.; Glasgow, Amy E.; Moody, Suzanne; Kotagal, Meera; Williams, Regan F.; Kayton, Mark L.; Alberto, Emily C.; Burd, Randall S.; Schroeppel, Thomas J.; Baerg, Joanne E.; Munoz, Amanda; Rothstein, William B.; Boomer, Laura A.; Campion, Eric M.; Robinson, Caitlin; Nygaard, Rachel M.; Richardson, Chad J.; Garcia, Denise I.; Streck, Christian J.; Gaffley, Michaela; Petty, John K.; Ryan, Mark; Pandya, Samir; [...]
  • Erschienen: Ovid Technologies (Wolters Kluwer Health), 2023
  • Erschienen in: Journal of Trauma and Acute Care Surgery
  • Sprache: Englisch
  • DOI: 10.1097/ta.0000000000004013
  • ISSN: 2163-0763; 2163-0755
  • Schlagwörter: Critical Care and Intensive Care Medicine ; Surgery
  • Entstehung:
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  • Beschreibung: <jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>This study examined differences in clinical and resuscitation characteristics between injured children with and without severe traumatic brain injury (sTBI) and aimed to identify resuscitation characteristics associated with improved outcomes following sTBI.</jats:p> </jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>This is a post hoc analysis of a prospective observational study of injured children younger than 18 years (2018–2019) transported from the scene, with elevated shock index pediatric-adjusted on arrival and head Abbreviated Injury Scale score of ≥3. Timing and volume of resuscitation products were assessed using χ<jats:sup>2</jats:sup> <jats:italic toggle="yes">t</jats:italic> test, Fisher's exact <jats:italic toggle="yes">t</jats:italic> test, Kruskal-Wallis, and multivariable logistic regression analyses.</jats:p> </jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>There were 142 patients with sTBI and 547 with non-sTBI injuries. Severe traumatic brain injury patients had lower initial hemoglobin (11.3 vs. 12.4, <jats:italic toggle="yes">p</jats:italic> &lt; 0.001), greater initial international normalized ratio (1.4 vs. 1.1, <jats:italic toggle="yes">p</jats:italic> &lt; 0.001), greater Injury Severity Score (25 vs. 5, <jats:italic toggle="yes">p</jats:italic> &lt; 0.001), greater rates of ventilator (59% vs. 11%, <jats:italic toggle="yes">p</jats:italic> &lt; 0.001) and intensive care unit (ICU) requirement (79% vs. 27%, <jats:italic toggle="yes">p</jats:italic> &lt; 0.001), and more inpatient complications (18% vs. 3.3%, <jats:italic toggle="yes">p</jats:italic> &lt; 0.001). Severe traumatic brain injury patients received more prehospital crystalloid (25% vs. 15%, <jats:italic toggle="yes">p</jats:italic> = 0.008), ≥1 crystalloid boluses (52% vs. 24%, <jats:italic toggle="yes">p</jats:italic> &lt; 0.001), and blood transfusion (44% vs. 12%, <jats:italic toggle="yes">p</jats:italic> &lt; 0.001) than non-sTBI patients. Among sTBI patients, receipt of ≥1 crystalloid bolus (n = 75) was associated with greater ICU need (92% vs. 64%, <jats:italic toggle="yes">p</jats:italic> &lt; 0.001), longer median ICU (6 vs. 4 days, <jats:italic toggle="yes">p</jats:italic> = 0.027) and hospital stay (9 vs. 4 days, <jats:italic toggle="yes">p</jats:italic> &lt; 0.001), and more in-hospital complications (31% vs. 7.5%, <jats:italic toggle="yes">p</jats:italic> = 0.003) than those who received &lt;1 bolus (n = 67). These findings persisted after adjustment for Injury Severity Score (odds ratio, 3.4–4.4; all <jats:italic toggle="yes">p</jats:italic> &lt; 0.010).</jats:p> </jats:sec> <jats:sec> <jats:title>CONCLUSION</jats:title> <jats:p>Pediatric trauma patients with sTBI received more crystalloid than those without sTBI despite having a greater international normalized ratio at presentation and more frequently requiring blood products. Excessive crystalloid may be associated with worsened outcomes, including in-hospital mortality, seen among pediatric sTBI patients who received ≥1 crystalloid bolus. Further attention to a crystalloid sparing, early transfusion approach to resuscitation of children with sTBI is needed.</jats:p> </jats:sec> <jats:sec> <jats:title>LEVEL OF EVIDENCE</jats:title> <jats:p>Therapeutic/Care Management; Level IV.</jats:p> </jats:sec>