Intravenous fluids given to a trauma victim at an accident site may not be the best treatment and in many cases may actually be counterproductive, increasing the risk that a patient will die, researchers said Tuesday. Taking the time to insert an IV line may delay getting the patient to the hospital where treatment can be initiated and administering fluids may not be the most appropriate treatment, according to the study, published online in the Annals of Surgery ahead of publication in the February issue of the journal.
Unfortunately, some states and jurisdictions mandate that paramedics and other responders begin IV fluids before they transport patients to hospitals, said Dr. Elliott R. Haut of the Johns Hopkins University School of Medicine, the lead author of the new study. In Maryland, for example, trauma patients must also have their spines immobilized and be fitted with a cervical collar before transport, even if they have been, say stabbed in the leg or shot in the arm. Some patients must be intubated onsite as well. In some cases, the time it takes to start an IV can exceed the time it takes to travel to the emergency room. Trauma surgeons have long debated the efficacy of "scoop and run" versus "stay and play," he added.
IV fluids are typically given immediately to trauma victims whose blood pressure has decreased sharply due to blood loss, the rationale being that the fluids quickly raise low blood pressure to keep the body's systems working. But, Haut said, there is some evidence that the fluids may make matters worse because the low blood pressure stops bleeding. Rapidly raising blood pressure "pops the clot," causing them to start bleeding again before they reach the hospital.
Haut and his colleagues examined data on 776,734 trauma patients from American College of Surgeons' National Trauma Data Bank for the years 2001 to 2005. The patients were primarily male, white and younger than 40, and about half were given IV fluids at the scene. Patients who received IV fluids at the scene of an accident were about 11% more likely to die. The problem was especially severe for those who were shot or stabbed (25% more likely to die), had severe head injuries (35% more likely to die) or who got emergency surgery once hospitalized (35% more likely).
One potential exception is traumatic brain injury, for which previous research has suggested that IV fluids are beneficial, said Haut, a trauma surgeon at Johns Hopkins.