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

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; Munoz, Amanda; Rothstein, William G.; Boomer, Laura A.; Campion, Eric M.; Robinson, Caitlin; Nygaard, Rachel M; Richardson, Chad J; Garcia, Denise; Streck, Christian J.; Gaffley, Michaela; Petty, John K.; Ryan, Mark; Pandya, Samir; Russell, Robert T.; Yorkgitis, Brian K.; Mull, Jennifer; Pence, Jeffrey C.; Santore, Matthew T.; Klinkner, Denise B.; Safford, Shawn D.; Trevilian, Tanya; Jensen, Aaron R.; Mooney, David P.; Ketha, Bavana; Dassinger, Melvin S.; Goldenberg‐Sandau, Anna; Falcone, Richard A.; Polites, Stephanie F.

doi:10.1097/ta.0000000000004013

J Trauma Acute Care Surg

2023

DOI: 10.1097/ta.0000000000004013

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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

Taleen A. MacArthur

Adam M. Vogel

Amy E. Glasgow

et al.

Abstract: Pediatric #trauma patients with severe #TBI receive more crystalloid than those without. Receipt of one or more crystalloid bolus is associated with worse outcomes among #pediatric #trauma patients with severe #TBI.

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Cited by 4 publications

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“…We have reviewed the original article by MacArthur et al 1 titled “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” with great interest. We greatly appreciate your efforts in conducting this study and feel the urge to share a few concerns and comments.…”

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confidence: 99%

Letter to the editor: Points to consider regarding crystalloid volume and short-term outcome in children with severe traumatic brain injury

Yousefi,

Ghasemian,

Paydar

2023

J Trauma Acute Care Surg

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mentioning

confidence: 99%

Letter to the editor: Points to consider regarding crystalloid volume and short-term outcome in children with severe traumatic brain injury

Yousefi,

Ghasemian,

Paydar

2023

J Trauma Acute Care Surg

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Fluid Management in Critically Ill Children: Single-Center Retrospective Comparison of Trauma and Postoperative Patients, 2020–2022*

Wu,

Gennell,

Porigow

et al. 2024

Pediatric Critical Care Medicine

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Objective: Injury and surgery both represent well-defined starting points of a predictable inflammatory response, but the consequent response to IV fluids has not been studied. We aimed to review and compare our single-center fluid management strategies in these two populations. Design: Retrospective cohort study from January 2020 to July 2022. The primary outcome was total IV fluid volume administered. Net fluid balances and select clinical outcomes were also evaluated. Setting: Single tertiary academic center and level 1 pediatric trauma center in New York. Patients: A dataset of critically ill trauma and surgical patients aged 0–18 years who were admitted to the PICU, 2020–2022. Trauma patients had at least moderate traumatic injuries (Injury Severity Score ≥ 9) and surgical patients had at least a 1-hour operation time. Interventions: None. Measurements and Main Results: We identified 25 trauma and 115 surgical patients. During the first 5 days of hospitalization, we did not identify an association between grouping and total IV fluids administered and fluid balance in the prehospital, emergency department, and operating room (p = 0.90 and p = 0.79), even when adjusted for weight (p = 0.96). Time trend graphs of net fluid balance and IV fluid administered illustrated analogous fluid requirement and response with the transition from net positive to net negative fluid balance between 48 and 72 hours. There was an association between total IV fluid and ventilator requirement (p = 0.003). Conclusions: Critically ill pediatric trauma and postoperative patients seem to have similar fluid management and balance after injury or surgery. In our opinion, these two critically ill populations could be combined in large prospective studies on optimal fluid therapy in critically ill children.

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How much is too much crystalloid? Building a foundation for the study of optimal resuscitation practices in pediatric trauma patients with severe traumatic brain injury: Authors' response to Ghasemian et al.

MacArthur,

Polites

2023

J Trauma Acute Care Surg

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conducting this study and feel the urge to share a few concerns and comments.First, the authors have concluded that "Severe traumatic brain injury patients who received one or more crystalloid boluses had greater rates of ICU admission and mechanical ventilation, longer median ICU length of stay, and more overall complications." In this regard, we think that the comparison groups could have been more properly matched. For instance, the primary shock index is an important feature to determine whether a patient needs more than one crystalloid bolus infusion 2 and also to predict the outcome of patients 3,4 ; thus, it is reasonable to compare the clinical outcomes of patients with the same primary shock index. Furthermore, the type of intervention used to manage traumatic brain injury and other organ injuries can also affect the end clinical outcome. Therefore, patients with the same injuries and the same interventions should be compared with each other so that the endpoint clinical outcomes can be more precisely evaluated.Monitoring the patients could have helped the results be more precise, for instance, if the patients were assessed appropriately regarding fluid responsiveness after administering one bolus of crystalloid. Blood pressure and pulse rate could have been reported to clarify fluid responsiveness in patients and determine their prognosis. Yet another measurable factor is intra-cranial pressure (ICP). Recent guidelines recommend measuring patients' ICP using intraparenchymal monitoring sensors and planning further management steps in accordance with that. 5 In conclusion, considering these factors would allow for a more accurate evaluation of the clinical outcomes of the children with severe traumatic brain injury receiving crystalloid boluses. Further research should be conducted to investigate these concerns and provide a more comprehensive understanding of the effects and management of severe traumatic brain injury. AUTHORSHIP M.G. and M.R.Y. contributed to writing the original draft and S.P. contributed to the supervision, reviewing, and editing. DISCLOSUREAll JTACS Disclosure forms have been supplied and are provided as supplemental digital content (http:// links.lww.com/TA/D452).

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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

Abstract: Pediatric #trauma patients with severe #TBI receive more crystalloid than those without. Receipt of one or more crystalloid bolus is associated with worse outcomes among #pediatric #trauma patients with severe #TBI.

Cited by 4 publications

References 25 publications

Letter to the editor: Points to consider regarding crystalloid volume and short-term outcome in children with severe traumatic brain injury

Letter to the editor: Points to consider regarding crystalloid volume and short-term outcome in children with severe traumatic brain injury

Fluid Management in Critically Ill Children: Single-Center Retrospective Comparison of Trauma and Postoperative Patients, 2020–2022*

How much is too much crystalloid? Building a foundation for the study of optimal resuscitation practices in pediatric trauma patients with severe traumatic brain injury: Authors' response to Ghasemian et al.

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