The effect of prehospital intravenous access in traumatic shock: a Japanese nationwide cohort study.

We aimed to evaluate effect of prehospital intravenous (IV) access on mortality in traumatic shock using a large nationwide dataset. We used the Japan Trauma Data Bank to identify adults (≥18 years) with a systolic blood pressure <90 mm Hg at the trauma scene and were directly transported to the hospital between 2010 and 2019. We compared patients who had prehospital IV access (IV (+)) or not (IV (-)), using propensity score-matched analysis, and 1:1 nearest-neighbor matching without replacement. Standardized mean difference was used to evaluate the match balance between the two matched groups; a standardized mean difference >0.1 was considered a significant imbalance. Primary outcome was 72-h mortality. Propensity scores matching generated 479 pairs from 5,857 patients. No significant between group differences occurred in 72-h mortality (7.8 versus 8.8%; difference, -1.0%; 95% confidence interval [CI]: -2.5-4.5%), 28-day mortality (11.8 versus 11.3%; 95% CI: -4.6-3.6%), blood transfusion administration within 24 h (55.3 versus 49.1%; 95% CI: -0.1-12.6%), prehospital time (56.3 versus 53.0 min; 95% CI: -1.8-8.4 min), and cardiopulmonary arrest on hospital arrival (1.3 versus 1.3%; 95% CI: -1.4-1.4%). However, significantly higher systolic blood pressure on hospital arrival was found in the IV (+) than in the IV (-) group (104.6 versus 100.1 mm Hg; 95% CI: 0.3-8.7 mm Hg). We found no significant effect of establishing IV access in the prehospital setting on survival outcomes of patients with traumatic shock.

Informations de copyright

© 2021 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf of Japanese Association for Acute Medicine.

Déclaration de conflit d'intérêts

Approval of the Research Protocol: The protocol for this research project has been approved by the medical ethics committee of Juntendo University Shizuoka Hospital, and it conforms to the provisions of the Declaration of Helsinki. (No. 807). Informed Consent: The need for informed consent was waived by the ethics committee because the data were collected from existing patient records and were anonymized to protect the confidentiality of patients’ information. Conflict of Interest: None declared.