1529: ASSOCIATION BETWEEN PREHOSPITAL FLUID THERAPY AND FIBRINOGEN LEVEL IN TRAUMA PATIENTS

AbstractIntroduction:To study the volume effect of isotonic and hypertonic crystalloid fluid during ambulance transports after mild trauma, a prospective case-control study was initiated, using the ambulance and helicopter transport system in Stockholm.Methods:The hemodilution resulting from intravenous infusion of 1.0 L of Ringer's acetate solution (n = 7) or 250 ml of 7.5% sodium chloride (n = 3) over 30 minutes (min) was measured every 10 min during 1 hour when fluid therapy was instituted at the scene of an accident, or on arrival at the hospital. The dilution was studied by volume kinetic analysis and compared to that of matched, healthy controls who received the same fluid in hospital.Result:The hemodilution at the end of the infusions averaged 7.7% in the trauma patients and 9.1% in the controls, but the dilution was better maintained after trauma. The kinetic analysis showed that the size of the body fluid space expanded by Ringer's solution was 4.6 L and 3.8 L for the trauma and the control patients, respectively, while hypertonic saline expanded a slightly larger space. For both fluids, trauma reduced the elimination rate constant by approximately 30%.Conclusion:Mild trauma prolonged the intravascular persistence of isotonic and hypertonic crystalloid fluid as compared to a control group.

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Relationship between initial fibrinogen level with coagulopathy and mortality in multiple trauma patients

International Surgery Journal ◽

10.18203/2349-2902.isj20170194 ◽

2017 ◽

Vol 4 (2) ◽

pp. 571

Author(s):

Reno Rudiman ◽

Lyana Sulistyanti ◽

Nurhayat Usman

Keyword(s):

Multiple Trauma ◽

Injury Severity ◽

Fibrinogen Level ◽

Coagulation Factors ◽

Bleeding Complications ◽

Trauma Patients ◽

Strongly Correlated ◽

Chi Square ◽

Multiple Trauma Patients ◽

Chi Square Analysis

Background: In trauma induced coagulopathy (TIC), low fibrinogen value is often found and plasma fibrinogen reached low value earlier than other parameters of coagulation factors. Initial fibrinogen value is strongly correlated to the injury severity score (ISS) and be an independent predictor of mortality. This study was expected to see the relationship between initial fibrinogen level with coagulopathy and mortality, so it can predict early coagulopathy and can prevent bleeding complications that lead to mortality. Methods: The study was conducted prospectively. The entire examination obtained from patients with multiple trauma. Fibrinogen levels and coagulopathy were taken from the blood laboratory tests in conjunction with other routine examination when patients were admitted to the ER of Hasan Sadikin General Hospital. Outcome parameters were the incidence of coagulopathy and mortality. Statistical analyses were performed to look at the significance of relationships.Results: Of the 25 patients with multiple trauma obtained a majority of 80% were male patients and with the highest incidence mechanism was head trauma as many as 16 people (64%). There were 8 patients (32%) experienced coagulopathy and mortality occurred in 7 patients (28%). Chi square analysis found a significant association between fibrinogen and coagulopathy (p = 0.043), while the association between initial fibrinogen with mortality was not significant (p = 0.341).Conclusions: Initial fibrinogen level is significantly associated with coagulopathy but it cannot predict mortality in patients with multiple trauma. Further study is needed in order to assess the benefit of these results on the management of multiple trauma patients.

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Impact Of Fibrinogen Level On The Prognosis Of Patients With Traumatic Brain Injury: A Single-Center Analysis Of 2570 Patients

10.21203/rs.3.rs-47508/v1 ◽

2020 ◽

Author(s):

Ke Lv ◽

Qiang Yuan ◽

Pengfei Fu ◽

Gang Wu ◽

Xing Wu ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Prognostic Factor ◽

Clinical Outcomes ◽

Fibrinogen Level ◽

Independent Prognostic Factor ◽

Trauma Patients ◽

Disease Prognosis ◽

Time Of Admission ◽

The Relationship

Abstract Background: Fibrinogen may play an important role in the survival of trauma patients; however, its role in traumatic brain injury (TBI) and its correlation with disease prognosis remain poorly understood. The aims of this study were to determine the incidence of TBI-associated hypofibrinogenemia in patients with TBI and to evaluate the prognostic value of fibrinogen level with respect to mortality and clinical outcomes. Methods: A total of 2570 consecutive TBI patients were retrospectively studied. Prognostic evaluations were determined using the Glasgow Outcome Score (GOS) assessment 3 months after injury. The shape of the relationship between fibrinogen level and mortality or outcome was examined using cubic spline functions. Logistic regression analyses were conducted to identify the association between fibrinogen level and 3-month functional outcomes.Results: Fibrinogen concentrations < 2 g/L were observed in 992 (38.6%) patients at the time of admission. Multivariate analyses showed that for patients with fibrinogen levels < 2.0 g/L, those levels were an independent prognostic factor for 3-month mortality (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.89–0.93; P < .001). By contrast, for patients with fibrinogen levels < 2.5 g/L, the levels were an independent prognostic factor for favorable outcomes at 3 months (OR, 1.654; 95% CI, 1.186–2.306; P = .003). Similar results were also seen for patients with fibrinogen levels > 3.0 g/L, with the levels being an independent prognostic factor for favorable outcomes at 3 months (OR, 0.771; 95% CI, 0.607–0.979; P = .033). Conclusions: Fibrinogen is an independent prognostic factor for clinical outcomes in TBI patients. Maintaining the level of fibrinogen between 2.5 and 3 g/L may improve clinical outcomes in patients with TBI.

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Prehospital fluid therapy in pediatric trauma patients

International Journal of Trauma Nursing ◽

10.1016/s1075-4210(96)80014-9 ◽

1996 ◽

Vol 2 (2) ◽

pp. 61

Author(s):

SJ Teach ◽

RE Antosia ◽

DP Lund ◽

GR Fleisher

Keyword(s):

Fluid Therapy ◽

Pediatric Trauma ◽

Trauma Patients

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Prehospital fluid therapy in pediatric trauma patients

Pediatric Emergency Care ◽

10.1097/00006565-199502000-00002 ◽

1995 ◽

Vol 11 (1) ◽

pp. 5-8 ◽

Cited By ~ 15

Author(s):

STEPHEN J. TEACH ◽

ROBERT E. ANTOSIA ◽

DENNIS P. LUND ◽

GARY R. FLEISHER

Keyword(s):

Fluid Therapy ◽

Pediatric Trauma ◽

Trauma Patients

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Prehospital Management and Fluid Resuscitation in Hypotensive Trauma Patients Admitted to Karolinska University Hospital in Stockholm

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00002582 ◽

2005 ◽

Vol 20 (4) ◽

pp. 228-234 ◽

Cited By ~ 17

Author(s):

Peep Talving ◽

Joakim Pålstedt ◽

Louis Riddez

Keyword(s):

Blood Pressure ◽

Fluid Resuscitation ◽

Fluid Therapy ◽

Injury Severity ◽

University Hospital ◽

Time Interval ◽

Trauma Patients ◽

Prehospital Management ◽

Type Of Injury ◽

Prehospital Time

AbstractIntroduction:Few previous studies have been conducted on the prehospital management of hypotensive trauma patients in Stockholm County. The aim of this study was to describe the prehospital management of hypotensive trauma patients admitted to the largest trauma center in Sweden, and to assess whether prehospital trauma life support (PHTLS) guidelines have been implemented regarding prehospital time intervals and fluid therapy. In addition, the effects of the age, type of injury, injury severity, prehospital time interval, blood pressure, and fluid therapy on outcome were investigated.Methods:This is a retrospective, descriptive study on consecutive, hypotensivetrauma patients (systolic blood pressure ≤90 mmHg on the scene of injury) admitted to Karolinska University Hospital in Stockholm, Sweden, during 2001–2003. The reported values are medians with interquartile ranges. Basic demographics, prehospital time intervals and interventions, injury severity scores (ISS), type and volumes of prehospital fluid resuscitation, and 30-day mortality were abstracted. The effects of the patient's age, gender, prehospital time interval, type of injury, injury severity, on-scene and emergency department blood pressure, and resuscitation fluid volumes on mortality were analyzed using the exact logistic regression model.Results:In 102 (71 male) adult patients (age ≥15 years) recruited, the median age was 35.5 years (range: 27–55 years) and 77 patients (75%) had suffered blunt injury. The predominant trauma mechanisms were falls between levels (24%) and motor vehicle crashes (22%) with an ISS of 28.5 (range: 16–50). The on-scene time interval was 19 minutes (range: 12–24 minutes). Fluid therapy was initiated at the scene of injury in the majority of patients (73%) regardless of the type of injury (77 blunt [75%] / 25 penetrating [25%]) or injury severity (ISS: 0–20; 21–40; 41–75). Age (odds ratio (OR) = 1.04), male gender (OR = 3.2), ISS 21–40 (OR = 13.6), and ISS >40 (OR = 43.6) were the significant factors affecting outcome in the exact logistic regression analysis.Conclusion:The time interval at the scene of injury exceeded PHTLS guidelines. The vast majority of the hypotensive trauma patients were fluid-resuscitated on-scene regardless of the type, mechanism, or severity of injury. A predefined fluid resuscitation regimen is not employed in hypotensive trauma victims with different types of injuries. The outcome was worsened by male gender, progressive age, and ISS >20 in the exact multiple regression analysis.

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Which injured patients with moderate fibrinogen deficit need fibrinogen supplementation?

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-021-00988-x ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Jean-Stephane David ◽

Aline Lambert ◽

Xavier-Jean Taverna ◽

Pascal Incagnoli ◽

Marie-Odile Geay-Baillat ◽

...

Keyword(s):

Linear Regression ◽

Fibrinogen Level ◽

Linear Regression Analysis ◽

Vital Signs ◽

Hemoglobin Level ◽

Base Deficit ◽

Trauma Patients ◽

Severely Injured ◽

Roc Curve Analysis ◽

Injured Patients

Abstract Background In severely injured patients, fibrinogen supplementation is recommended when fibrinogenemia is < 1.5 g L−1, but some teams have suggested to use higher thresholds (fibrinogenemia < 2.0 g L−1 or FIBTEM clot amplitude at 5 min (A5) values < 11 mm). The goal of this study was to specify in patients with a moderate fibrinogen deficit (MFD) whether some admission characteristics would be associated with fibrinogen administration at 24 h. Methods Prospective analysis of retrospectively collected data from a trauma registry (01/2011–12/2019). MFD-C was defined by a fibrinogenemia 1.51–1.99 g L−1 or the corresponding FIBTEM-A5 values (MFD-A5) that were determined from linear regression and ROC curve analysis. Administration of fibrinogen were described according to the following admission parameters: shock index (SI) > 1, hemoglobin level < 110 g L−1 (HemoCue®), and base deficit > 5 mEq L−1. Data are expressed as count (%), median [IQR]. Results 1076 patients were included in the study and 266 (27%) had MFD-C, among them, 122/266 (46%) received fibrinogen. Patients with MFD-C who received fibrinogen were more severely injured (ISS: 27 [19–36] vs. 24 [17–29]) and had more impaired vital signs (base deficit: 5.4 [3.6–7.8] vs. 3.8 [2.0–6.0]). Linear regression analysis found a positive correlation between fibrinogen level and FIBTEM-A5 (r: 0.805). For a fibrinogen level < 1.5 g L−1 and < 2.0 g L−1, FIBTEM-A5 thresholds were 6 mm (sensitivity 85%, specificity 83%, AUC: 0.934) and 9 mm (sensitivity 84%, specificity 69%, AUC: 0.874), respectively. MFD-A5 values (185 (27%) patients) were defined as a FIBTEM-A5 between 7 and 9 mm. More than 50% of MFD-C patients presenting a SI > 1, a hemoglobin level < 110 g L−1, or a base deficit > 5.0 mEq L−1 received fibrinogen. The relative risk [95% CI] for fibrinogen administration (SI > 1) were 1.39 [1.06–1.82] for MFD-C, and 2.17 [1.48–3.19] for MFD-A5. Results were not modified after adjustment on the ISS. Conclusions We have shown in this study an association between shock parameters and fibrinogen administration. Further studies are needed to determine how these parameters may be used to guide fibrinogen administration in trauma patients with MFD.

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Impact of fibrinogen level on the prognosis of patients with traumatic brain injury: A single-center analysis of 2570 patients

10.21203/rs.3.rs-47508/v2 ◽

2020 ◽

Author(s):

Ke Lv ◽

Qiang Yuan ◽

Pengfei Fu ◽

Gang Wu ◽

Xing Wu ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Prognostic Factor ◽

Clinical Outcomes ◽

Fibrinogen Level ◽

Independent Prognostic Factor ◽

Trauma Patients ◽

Disease Prognosis ◽

Time Of Admission ◽

The Relationship

Abstract Background: Fibrinogen may play an important role in the survival of trauma patients; however, its role in traumatic brain injury (TBI) and its correlation with disease prognosis remain poorly understood. The aims of this study were to determine the incidence of TBI-associated hypofibrinogenemia in patients with TBI and to evaluate the prognostic value of fibrinogen level with respect to mortality and clinical outcomes. Methods: A total of 2570 consecutive TBI patients were retrospectively studied. Prognostic evaluations were determined using the Glasgow Outcome Score (GOS) assessment 3 months after injury. The shape of the relationship between fibrinogen level and mortality or outcome was examined using cubic spline functions. Logistic regression analyses were conducted to identify the association between fibrinogen level and 3-month functional outcomes.Results: Fibrinogen concentrations < 2 g/L were observed in 992 (38.6%) patients at the time of admission. Multivariate analyses showed that for patients with fibrinogen levels < 2.0 g/L, those levels were an independent prognostic factor for 3-month mortality (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.89–0.93; P < .001). By contrast, for patients with fibrinogen levels < 2.5 g/L, the levels were an independent prognostic factor for favorable outcomes at 3 months (OR, 1.654; 95% CI, 1.186–2.306; P = .003). Similar results were also seen for patients with fibrinogen levels > 3.0 g/L, with the levels being an independent prognostic factor for favorable outcomes at 3 months (OR, 0.771; 95% CI, 0.607–0.979; P = .033). Conclusions: Fibrinogen is an independent prognostic factor for clinical outcomes in TBI patients. Maintaining the level of fibrinogen between 2.5 and 3 g/L may improve clinical outcomes in patients with TBI.

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Impact of fibrinogen level on the prognosis of patients with traumatic brain injury: a single-center analysis of 2570 patients

World Journal of Emergency Surgery ◽

10.1186/s13017-020-00332-1 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Ke Lv ◽

Qiang Yuan ◽

Pengfei Fu ◽

Gang Wu ◽

Xing Wu ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Prognostic Factor ◽

Clinical Outcomes ◽

Fibrinogen Level ◽

Independent Prognostic Factor ◽

Trauma Patients ◽

Disease Prognosis ◽

Time Of Admission ◽

The Relationship

Abstract Background Fibrinogen may play an important role in the survival of trauma patients; however, its role in traumatic brain injury (TBI) and its correlation with disease prognosis remain poorly understood. The aims of this study were to determine the incidence of TBI-associated hypofibrinogenemia in patients with TBI and to evaluate the prognostic value of fibrinogen level with respect to mortality and clinical outcomes. Methods A total of 2570 consecutive TBI patients were retrospectively studied. Prognostic evaluations were determined using the Glasgow Outcome Score (GOS) assessment 3 months after injury. The shape of the relationship between fibrinogen level and mortality or outcome was examined using cubic spline functions. Logistic regression analyses were conducted to identify the association between fibrinogen level and 3-month functional outcomes. Results Fibrinogen concentrations < 2 g/L were observed in 992 (38.6%) patients at the time of admission. Multivariate analyses showed that for patients with fibrinogen levels < 2.0 g/L, those levels were an independent prognostic factor for 3-month mortality (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.89–0.93; P < .001). By contrast, for patients with fibrinogen levels < 2.5 g/L, the levels were an independent prognostic factor for favorable outcomes at 3 months (OR, 1.654; 95% CI, 1.186–2.306; P = .003). Similar results were also seen for patients with fibrinogen levels > 3.0 g/L, with the levels being an independent prognostic factor for favorable outcomes at 3 months (OR, 0.771; 95% CI, 0.607–0.979; P = .033). Conclusions Fibrinogen is an independent prognostic factor for clinical outcomes in TBI patients. Maintaining the level of fibrinogen between 2.5 and 3 g/L may improve clinical outcomes in patients with TBI.

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