Does prehospital fluid administration impact core body temperature and coagulation functions in combat casualties?

Farkash, Uri; Lynn, Mauricio; Scope, Alon; Maor, Ron; Turchin, Nickolai; Sverdlik, Borris; Eldad, Arieh

doi:10.1016/s0020-1383(01)00149-8

Cited by 40 publications

(22 citation statements)

References 15 publications

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“…19 In a recent report from Israel, soldiers who had sustained a combat injury showed no correlation between the PT or PTT measured on hospital arrival and volume of prehospital fluid treatment. 20 Because our coagulation profile is measured early in the postinjury period, an abnormal finding at this time may reflect a primary influence on an increased risk of trauma-related death rather than being secondary to commonly held mechanisms such as massive fluid resuscitation.…”

Section: Discussionmentioning

confidence: 99%

Early Coagulopathy Predicts Mortality in Trauma

Macleod

Lynn

McKenney

et al. 2003

The Journal of Trauma: Injury, Infection, and Critical Care

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1,083

711

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Section: Discussionmentioning

confidence: 99%

Early Coagulopathy Predicts Mortality in Trauma

Macleod

Lynn

McKenney

et al. 2003

The Journal of Trauma: Injury, Infection, and Critical Care

Self Cite

1,083

711

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“…It has been reported that prehospital fluid resuscitation of burn patients is often excessive 14 but that fluid resuscitation of combat casualties does not necessarily result in hypothermia. 15 However, studies in healthy volunteers have shown that rapid infusion of 30 ml/kg of 23°C normal saline in healthy volunteers reduces core body temperature by 0.5°C and that cold saline infusions reduce temperature by more than 1.0°C. 16,17 Fluid resuscitation did not differ between the hypothermic and normothermic groups in the present report.…”

Section: Discussionmentioning

confidence: 99%

Admission Temperature and Survival in Patients Admitted to Burn Centers

Hostler

Weaver

Ziembicki

et al. 2013

Journal of Burn Care & Research

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It is commonly believed that hypothermia occurring during burn resuscitation is associated with poor outcome, but there is little direct supporting evidence. The authors conducted an analysis of a statewide trauma registry to determine whether hypothermia (T ≤36.5°C) was associated with mortality when controlling for clinical confounders. They included all patients treated at an accredited burn center from 2000 to 2011 where the trauma registrar recorded the primary injury type as a burn. They excluded records with missing data and nonphysiologic temperature (<26°C or >42°C). The primary exposure of interest was hypothermia. The authors constructed a hierarchical, multivariable logistic regression model to examine the effect of hypothermia on survival, controlling for potentially confounding variables. Predictors of mortality are presented as odds ratio (95% confidence interval). Primary burn injury was coded 17,098 times during the study period. Of these, 3809 were not treated at a burn center and 1192 were excluded for missing data. Admission hypothermia was independently associated with mortality (1.91 [1.58-2.29]) when adjusting for age, sex, total second- and third-degree burn surface area (TBSA), comorbid conditions, injury severity score, direct transport vs referral, method of temperature measurement, year, and the hospital providing care. Increasing age, female sex, TBSA >40%, presence of multiple comorbid conditions, and increasing injury severity score were associated with mortality. Other variables in the model were not independently associated with outcome. There was a weak correlation between TBSA and admission temperature (r = .18). Hypothermia at hospital admission is independently associated with mortality in burn patients when controlling for clinical confounders. Future studies should address potential causes underlying this observation.

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“…Patients exposed to long transport times or aggressive intravenous fluid therapy may be more susceptible to hypothermia, and mortality may be related to all of these factors (34,35). Therefore, we considered additional covariate adjustment for the following variables: elapsed injury-to-emergency-department time, volume of administered prehospital intravenous fluids, and their interaction (injury to emergency department time ϫ prehospital intravenous fluids).…”

Section: Methodsmentioning

confidence: 99%