Article Figures & Data
- Figure 1
Flowchart of included patients. *Isolated traumatic brain injury (TBI) was defined as Abbreviated Injury Score (AIS) head >3 and AIS <2 or less in other regions.
- Figure 2
Blood products related to crystalloid administration ≤24 hours. FFP, fresh frozen plasma; OR, operating room; PRBC, packed red blood cell.
- Figure 3
Adjusted ORs for the development of (A) MODS, (B) ARDS, (C) infectious complications and (D) mortality across the four crystalloid resuscitation volume groups. ARDS, adult respiratory distress syndrome; MODS, multiple organ dysfunction syndrome.
- Table 1
Demographics
Demographics Total population
(n=367)Age (years) 46 (28–61) Male gender 256 (70%) Blunt MOI 351 (96%) Urgent laparotomy 86 (23%) ISS 29 (22–35) AIS head 3 (1–3) AIS face 0 (0–2) AIS chest 3 (2–4) AIS abdomen 2 (0–3) AIS pelvis/extremities 2 (0–3) AIS external 0 (0–1) SBP_ED (mm Hg) 120 (100–140) SBP <90 mmHg_ED 70 (19%) Hb_ED (mmol/L) 8.0 (7.2–8.9) BD _ED (mmol/L) 3.0 (0.0–6.0) PT_ED (sec) 14.7 (13.2–16.8) SBP _ICU (mm Hg) 119 (105–136) Hb_ICU (mmol/L) 7.6 (6.8–8.3) BD_ICU (mmol/L) 3.8 (1.8–6.0) Resuscitation parameters Crystalloids <8 hours (L) 4.6 (2.3–6.3) PRBC <8 hours (U) 1 (0–4) FFP <8 hours (U) 0 (0–4) PLT <8 hours (U)* 0 (0–0) Crystalloids <24 hours (L) 7.4 (5.0–10.2) PRBC <24 hours (U) 1 (0–5) PRBC >10 U <24 hours 37 (10%) FFP <24 hours (U) 0 (0–5) PLT <24 hours (U)* 0 (0–1) Outcome parameters Ventilator days 6 (2–11) ICU-LOS (days) 7 (3–14) H-LOS (days) 21 (13–32) MODS 62 (17%) ARDS 16 (4%) Infectious complications 165 (45%) Mortality 51 (14%) Data are expressed in median (IQR) or absolute numbers (%).
*1 U of platelets contains five donors.
AIS, Abbreviated Injury Scale; ARDS, adult respiratory distress syndrome; BD, base deficit; ED, emergency department; FFP, fresh frozen plasma; Hb, hemoglobin; H-LOS, hospital length of stay; ICU, intensive care unit; ISS, Injury Severity Score; LOS, length of stay; MODS, multiple organ dysfunction syndrome; MOI, mechanism of injury; PLT, platelet; PRBC, packed red blood cell; PT, prothrombin time; SBP, systolic blood pressure.
- Table 2
Distribution of injury severity across different crystalloid volume groups and dose-dependent effect of crystalloid resuscitation on morbidity and mortality
N=348* 0–5 L
(n=86)5–10 L
(n=168)10–15 L
(n=75)>15 L
(n=19)P value Age (years) 48 (32–64) 46 (26–61) 45 (28–61) 40 (33–55) 0.24 Male gender 57 (66%) 117 (70%) 55 (73%) 13 (68%) 0.46 Urgent laparotomy 4 (5%) 36 (21%) 31 (41%) 11 (58%) <0.001† Pelvic fracture 25 (29%) 40 (24%) 27 (36%) 8 (42%) 0.14 ISS 22 (17–29) 29 (24–35) 34 (24–38) 29 (24–41) <0.001† SBP_ED (mm Hg) 135 (117–150) 120 (100–137) 106 (83–120) 105 (75–136) <0.001† SBP <90 mmHg_ED 7 (8%) 28 (17%) 24 (32%) 8 (42%) <0.001† Hb_ED (mmol/L) 8.4 (7.8–9.2) 8.0 (7.4–8.9) 7.4 (6.5–8.4) 7.6 (6.3–8.6) <0.001† BD_ED (mmol/L) 1.0 (-1.0–3.8) 2.5 (0.0–5.0) 5.0 (2.5–9.0) 8.0 (3.6–9.3) <0.001† PT_ED (s) 13.9 (12.4–15.2) 14.5 (13.2–16.5) 16.0 (14.0–18.6) 17.5 (14.7–19.2) <0.001† Hb_ICU (mmol/L) 8.0 (7.3–8.5) 7.6 (6.8–8.3) 7.1 (6.5–7.7) 7.4 (6.3–7.9) <0.001† BD_ICU 2.8 (1.4–5.3) 3.9 (1.5–6.2)) 4.9 (2.5–7.5) 4.2 (3.1–7.9) <0.001† PRBC <24 hours (U) 0 (0–0) 1 (0–4) 5 (2–9) 7 (2–14) <0.001† FFP <24 hours (U) 0 (0–0) 0 (0–4) 5 (2–8) 4 (2–12) <0.001† PLT <24 hours (U) 0 (0–0) 0 (0–1) 0 (0–2) 1 (0–3) <0.001† Ventilator days 3 (2–8) 7 (2–11) 8 (5–12) 12 (9–22) <0.001† ICU-LOS (days) 5 (2–9) 8 (4–15) 9 (6–14) 17 (9–24) <0.001† H-LOS (days) 15 (10–23) 24 (15–34) 23 (9–34) 35 (16–54) <0.001† MODS 8 (9%) 27 (16%) 19 (25%) 8 (42%) <0.001† ARDS 1 (1%) 8 (5%) 3 (4%) 2 (11%) 0.10 Infectious complications 27 (31%) 84 (50%) 36 (48%) 12 (63%) 0.007† Mortality 6 (7%) 17 (10%) 21 (28%) 6 (32%) <0.001† Data are expressed as median (IQR) or absolute numbers (%).
*Nineteen patients stayed in ICU less than 24 hours; therefore, they did not have crystalloid and blood product measurement for full 24 hours.
†Statistically significant.
ARDS, adult respiratory distress syndrome; BD, base deficit; FFP, fresh frozen plasma; Hb, hemoglobin; H-LOS, hospital length of stay; ICU, intensive care unit; ISS, Injury Severity Score; LOS, length of stay; MODS, multiple organ dysfunction syndrome; PLT, platelet; PRBC, packed red blood cell; PT, prothrombin time; SBP, systolic blood pressure.
- Table 3
Multinominal logistic regression analysis identifying possible predictors for different crystalloid volume groups
0–5 L 5–10 L
OR (95% CI)P value 10–15 L
OR (95% CI)P value >15 L
OR (95% CI)P value ISS Reference 1.1 (1.0 to 1.1) 0.003 1.0 (1.0 to 1.1) 0.06 1.0 (1.0 to 1.1) 0.19 Hb_ED Reference 1.0 (1.0 to 1.0) 0.77 1.0 (0.9 to 1.0) 0.17 1.0 (0.9 to 1.0) 0.86 BD_ED Reference 1.0 (1.0 to 1.0) 0.37 1.0 (1.0 to 1.0) 0.01 1.0 (1.0 to 1.0) 0.01 Urgent laparotomy Reference 6.7 (1.3 to 34.2) 0.02 12.6 (2.3 to 70.0) 0.004 30.0 (3.9 to 229) 0.001 PRBC <8 hours Reference 1.6 (0.8 to 3.0) 0.18 1.8 (0.9 to 3.5) 0.10 1.1 (0.5 to 2.4) 0.73 PRBC <24 hours Reference 1.1 (0.7 to 1.8) 0.73 1.9 (0.2 to 25.3) 0.69 1.9 (1.0 to 3.5) 0.04 FFP <8 hours Reference 0.5 (0.3 to 1.1) 0.07 0.6 (0.3 to 1.1) 0.08 0.6 (0.3 to 1.3) 0.18 FFP <24 hours Reference 1.4 (0.9 to 2.4) 0.17 1.4 (0.8 to 2.3) 0.27 1.0 (0.5 to 1.8) 0.94 MODS Reference 1.2 (0.5 to 3.0) 0.73 1.9 (0.6 to 6.0) 0.24 4.3 (1.0 to 19.7) 0.06 ARDS Reference 3.5 (0.4 to 35.2) 0.28 1.9 (0.2 to 28.2) 0.63 3.7 (0.2 to 68.6) 0.38 Infectious complications Reference 1.9 (1.0 to 3.5) 0.05 1.6 (0.7 to 3.5) 0.28 2.7 (0.7 to 10.4) 0.15 Mortality Reference 1.1 (0.4 to 3.2) 0.86 3.1 (1.0 to 10.1) 0.06 5.9 (1.2 to 29.5) 0.03 ARDS, adult respiratory distress syndrome; BD, base deficit; ED, emergency department; FFP, fresh frozen plasma; ISS, Injury Severity Score; MODS, multiple organ dysfunction syndrome; PRBC, packed red blood cell.
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