RT Journal Article
SR Electronic
T1 Significance of initial hemoglobin levels in severe trauma patients without prehospital fluid administration: a single-center study in Japan
JF Trauma Surgery & Acute Care Open
JO Trauma Surg Acute Care Open
FD BMJ Publishing Group Ltd
SP e000831
DO 10.1136/tsaco-2021-000831
VO 6
IS 1
A1 Yasuyuki Kawai
A1 Hidetada Fukushima
A1 Hideki Asai
A1 Keisuke Takano
A1 Akinori Okuda
A1 Yusuke Tada
A1 Naoki Maegawa
A1 Francesco Bolstad
YR 2021
UL http://tsaco.bmj.com/content/6/1/e000831.abstract
AB Objectives Hemoglobin (Hb) levels have been considered to remain stable in the early stages of bleeding due to trauma. However, several studies have reported that rapid compensatory fluid shifts cause Hb dilution earlier than previously thought. These reports are from Western countries where it is standard protocol to administer fluids during an emergency, making it almost impossible to eliminate the effect of prehospital intravenous fluid administration on Hb levels. This study aimed to determine the relationship between Hb levels and severity of injury on arrival at the hospital in severe trauma patients without prehospital intravenous fluid administration.Methods This single-center observational retrospective study included patients with Abbreviated Injury Scale scores of 3 or above between 2008 and 2014. In Japan, prehospital life-saving technicians were not allowed to administer intravenous fluids until 2014. We investigated whether the difference between the measured blood Hb level at arrival and the corresponding standard blood Hb level for each age group and sex reported in the national survey was associated with the severity of injury and the need for hemostasis.Results In total, 250 patients were included in this study (median age, 46 years; male patients, 183). The median time from injury to arrival at the hospital was 45 min, and there was no statistical correlation with the initial Hb level on arrival (ρ=0.092, p=0.14). When the study subjects were stratified into four groups according to the initial Hb levels, lower Hb levels correlated with higher rates of requirement for hemostatic interventions (p=0.02) and mortality (p=0.02). In addition, lower Hb levels were associated with the need for hemostasis.Conclusion In severe trauma patients without prehospital intravenous fluid administration, decreased Hb levels on arrival may be associated with the severity of trauma and with the need for hemostasis.Level of evidence Level IV.All data relevant to the study are included in the article or uploaded as supplementary information.