J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 7, Number 12, December 2015, pages 947-955

Benefits of Initial Limited Crystalloid Resuscitation in Severely Injured Trauma Patients at Emergency Department

Figure 2. The comparisons of mortality between patients receiving different amounts of crystalloid resuscitations. *Statistically significant difference between two groups (P < 0.01).

Figure 3. The comparisons of the amount of crystalloid resuscitation, blood transfusion volume, mortalities, and injury severity scores in trauma patients each year from 2004 until 2013.

Figure 4. The association between crystalloid resuscitation and PRBC transfusions in ED trauma patients of different groups.

Figure 5. The association of C/PRBC ratio and the length of ED, ICU, and hospitalization using confidence band around regression prediction.

**Table 1.** A Comparison of Crystalloid Fluid Resuscitation Among Pelvic Patients Receiving Blood Transfusions in Emergency Department
	Patients who received < 2,000 mL crystalloid (N = 210)	Patients who received ≥ 2,000 mL crystalloid (N = 423)	P value
RTS: revised trauma score; ISS: injury severity score; SBP: systolic blood pressure; GCS: Glasgow coma scale; LOS: length of stay; C/PRBC: crystalloid to packed red blood cell ratio; CI: confidence interval.
General demographics
Age (years)	38.09 ± 16.46	41.03 ± 18.19	0.05
Gender (male, %)	80.95%	77.54%	0.32
Race (white, %)	52.38%	59.57%	0.26
Mode of arrival (ambulance/helicopter, %)	92.86%	95.98%	0.09
ED clinical variables
RTS on arrival	4.66 ± 2.81	4.96 ± 2.62	0.22
ISS on arrival	25.5 ± 18.7	28.5 ± 17.6	0.05
ED SBP (mm Hg, mean ± SD, 95%CI)	81 ± 48 (74 - 88)	87 ± 42 (83 - 91)	0.13
ED HR (bpm, mean ± SD, 95% CI)	93 ± 48 (87 - 100)	96 ± 43 (92 - 100)	0.52
ED RR (times, mean ± SD, 95% CI)	14 ± 9 (13 - 16)	15 ± 9 (14 - 16)	0.66
GCS (mean ± SD)	8.0 ± 5.4 (7.3 - 8.8)	8.3 ± 5.4 (7.8 - 8.8)	0.58
Hgb (mg/dL, mean ± SD)	11.3 ± 2.5 (10.9 - 11.7)	11.1 ± 2.4 (10.8 - 11.3)	0.29
ED total crystal fluid received (mL, mean ± SD)	1,352 ± 621 (1,267 - 1,437)	3,870 ± 1,419 (3,734 - 4,006)	< 0.01
ED blood transfusion (units, mean ± SD)	2.53 ± 1.51 (2.32-2.73)	3.01 ± 1.97 (2.82 - 3.20)	< 0.01
ED total LOS (h, mean ± SD)	0.8 ± 1.2 (0.7-1.0)	1.3 ± 1.8 (1.1 - 1.5)	< 0.01
C/PRBC ratio (ratio, mean ± SD)	0.71 ± 0.54	1.70 ± 1.02	< 0.01
In-hospital variables
Mortality (n, %)	108/210 (51.43%)	189/423 (44.68%)	0.11
Early mortality (n, %)	89/108 (82.41%)	155/189 (82.01%)	0.93
ICU LOS (days, mean ± SD, 95% CI))	7.0 ± 11.4 (5.5 - 8.6)	9.2 ± 13.0 (8.0 - 10.5)	0.04
Hospital LOS (days, mean ± SD, 95% CI)	9.7 ± 15.4 (7.6 - 11.8)	12.3 ± 16.4 (10.7 - 13.9)	0.06

Table 1. A Comparison of Crystalloid Fluid Resuscitation Among Pelvic Patients Receiving Blood Transfusions in Emergency Department

Patients who received < 2,000 mL crystalloid (N = 210)

Patients who received ≥ 2,000 mL crystalloid (N = 423)

P value

RTS: revised trauma score; ISS: injury severity score; SBP: systolic blood pressure; GCS: Glasgow coma scale; LOS: length of stay; C/PRBC: crystalloid to packed red blood cell ratio; CI: confidence interval.

General demographics

Age (years)

38.09 ± 16.46

41.03 ± 18.19

0.05

Gender (male, %)

80.95%

77.54%

0.32

Race (white, %)

52.38%

59.57%

0.26

Mode of arrival (ambulance/helicopter, %)

92.86%

95.98%

0.09

ED clinical variables

RTS on arrival

4.66 ± 2.81

4.96 ± 2.62

0.22

ISS on arrival

25.5 ± 18.7

28.5 ± 17.6

0.05

ED SBP (mm Hg, mean ± SD, 95%CI)

81 ± 48 (74 - 88)

87 ± 42 (83 - 91)

0.13

ED HR (bpm, mean ± SD, 95% CI)

93 ± 48 (87 - 100)

96 ± 43 (92 - 100)

0.52

ED RR (times, mean ± SD, 95% CI)

14 ± 9 (13 - 16)

15 ± 9 (14 - 16)

0.66

GCS (mean ± SD)

8.0 ± 5.4 (7.3 - 8.8)

8.3 ± 5.4 (7.8 - 8.8)

0.58

Hgb (mg/dL, mean ± SD)

11.3 ± 2.5 (10.9 - 11.7)

11.1 ± 2.4 (10.8 - 11.3)

0.29

ED total crystal fluid received (mL, mean ± SD)

1,352 ± 621 (1,267 - 1,437)

3,870 ± 1,419 (3,734 - 4,006)

< 0.01

ED blood transfusion (units, mean ± SD)

2.53 ± 1.51 (2.32-2.73)

3.01 ± 1.97 (2.82 - 3.20)

< 0.01

ED total LOS (h, mean ± SD)

0.8 ± 1.2 (0.7-1.0)

1.3 ± 1.8 (1.1 - 1.5)

< 0.01

C/PRBC ratio (ratio, mean ± SD)

0.71 ± 0.54

1.70 ± 1.02

< 0.01

In-hospital variables

Mortality (n, %)

108/210 (51.43%)

189/423 (44.68%)

0.11

Early mortality (n, %)

89/108 (82.41%)

155/189 (82.01%)

0.93

ICU LOS (days, mean ± SD, 95% CI))

7.0 ± 11.4 (5.5 - 8.6)

9.2 ± 13.0 (8.0 - 10.5)

0.04

Hospital LOS (days, mean ± SD, 95% CI)

9.7 ± 15.4 (7.6 - 11.8)

12.3 ± 16.4 (10.7 - 13.9)

0.06

**Table 2.** A Comparison of Outcome Measurements in Trauma Patients Who Received Different Crystalloid Resuscitation at Emergency Department
	Patients who received < 2,000 mL crystalloid	Patients who received ≥ 2,000 mL crystalloid	P value
Total trauma patients at ED	210	423
C/PRBC ratio (ratio, mean ± SD)	0.71 ± 0.54	1.70 ± 1.02	< 0.01
Mortality (n, %)	108/210 (51%)	189/423 (45%)	0.11
Early mortality (n, %)	89/108 (82%)	155/189 (82%)	0.93
Late mortality (n, %)	19/108 (16%)	34/189 (18%)	0.93
ED total LOS (h, mean ± SD)	0.8 ± 1.2 (0.7 - 1.0)	1.3 ± 1.8 (1.1-1.5)	< 0.01
ICU LOS (days, mean ± SD, 95% CI))	7.0 ± 11.4 (5.5 - 8.6)	9.2 ± 13.0 (8.0-10.5)	0.04
Hospital LOS (days, mean ± SD, 95% CI)	9.7 ± 15.4 (7.6 - 11.8)	12.3 ± 16.4 (10.7-13.9)	0.06
ED admitted to ICU	63/210 (30%)	177/423 (42%)
C/PRBC ratio (ratio, mean ± SD)	0.76 ± 0.60	1.80 ± 1.06	< 0.01
Mortality (n, %)	26/63 (41%)	66/177 (37%)	0.58
Early mortality (n, %)	16/26 (62%)	46/66 (70%)	0.45
Late mortality (n, %)	10/26 (38%)	20/66 (30%)	0.45
ED total LOS (h, mean ± SD)	1.6 ± 1.8 (1.1 - 2.0)	1.5 ± 1.3 (1.3 - 1.7)	0.58
ICU LOS (days, mean ± SD, 95% CI))	10.04 ± 12.71	12.06 ± 15.66	0.36
Hospital LOS (days, mean ± SD, 95% CI)	12.55 ± 17.60	16.15 ± 20.30	0.21
ED transferred to OR	111/210 (53%)	187/423 (44%)
C/PRBC ratio (ratio, mean ± SD)	0.72 ± 0.52	1.64 ± 0.99	< 0.01
Mortality (n, %)	51/111 (46%)	79/187 (42%)	0.53
Early mortality (n, %)	42/51 (82%)	65/79 (82%)	0.99
Late mortality (n, %)	9/51 (18%)	14/79 (18%)	0.99
ED total LOS (h, mean ± SD)	0.4 ± 0.4 (0.3 - 0.5)	0.8 ± 0.8 (0.7 - 1.0)	< 0.01
ICU LOS (day, mean ± SD, 95% CI)	7.63 ± 11.74	9.12 ± 11.04	0.27
Hospital LOS (days, mean ± SD, 95% CI)	11.00 ± 15.81	11.82 ± 13.26	0.63

Table 2. A Comparison of Outcome Measurements in Trauma Patients Who Received Different Crystalloid Resuscitation at Emergency Department

Patients who received < 2,000 mL crystalloid

Patients who received ≥ 2,000 mL crystalloid

P value

Total trauma patients at ED

210

423

C/PRBC ratio (ratio, mean ± SD)

0.71 ± 0.54

1.70 ± 1.02

< 0.01

Mortality (n, %)

108/210 (51%)

189/423 (45%)

0.11

Early mortality (n, %)

89/108 (82%)

155/189 (82%)

0.93

Late mortality (n, %)

19/108 (16%)

34/189 (18%)

0.93

ED total LOS (h, mean ± SD)

0.8 ± 1.2 (0.7 - 1.0)

1.3 ± 1.8 (1.1-1.5)

< 0.01

ICU LOS (days, mean ± SD, 95% CI))

7.0 ± 11.4 (5.5 - 8.6)

9.2 ± 13.0 (8.0-10.5)

0.04

Hospital LOS (days, mean ± SD, 95% CI)

9.7 ± 15.4 (7.6 - 11.8)

12.3 ± 16.4 (10.7-13.9)

0.06

ED admitted to ICU

63/210 (30%)

177/423 (42%)

C/PRBC ratio (ratio, mean ± SD)

0.76 ± 0.60

1.80 ± 1.06

< 0.01

Mortality (n, %)

26/63 (41%)

66/177 (37%)

0.58

Early mortality (n, %)

16/26 (62%)

46/66 (70%)

0.45

Late mortality (n, %)

10/26 (38%)

20/66 (30%)

0.45

ED total LOS (h, mean ± SD)

1.6 ± 1.8 (1.1 - 2.0)

1.5 ± 1.3 (1.3 - 1.7)

0.58

ICU LOS (days, mean ± SD, 95% CI))

10.04 ± 12.71

12.06 ± 15.66

0.36

Hospital LOS (days, mean ± SD, 95% CI)

12.55 ± 17.60

16.15 ± 20.30

0.21

ED transferred to OR

111/210 (53%)

187/423 (44%)

C/PRBC ratio (ratio, mean ± SD)

0.72 ± 0.52

1.64 ± 0.99

< 0.01

Mortality (n, %)

51/111 (46%)

79/187 (42%)

0.53

Early mortality (n, %)

42/51 (82%)

65/79 (82%)

0.99

Late mortality (n, %)

9/51 (18%)

14/79 (18%)

0.99

ED total LOS (h, mean ± SD)

0.4 ± 0.4 (0.3 - 0.5)

0.8 ± 0.8 (0.7 - 1.0)

< 0.01

ICU LOS (day, mean ± SD, 95% CI)

7.63 ± 11.74

9.12 ± 11.04

0.27

Hospital LOS (days, mean ± SD, 95% CI)

11.00 ± 15.81

11.82 ± 13.26

0.63