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The clinical effectiveness of pre-hospital intravenous fluid replacement in trauma patients without head injury: a systematic review

Department of Public Health and Epidemiology, University of Birmingham, Birmingham, UK, j.dretzke{at}bham.ac.uk

Amanda Burls

Department of Public Health and Epidemiology, University of Birmingham, Birmingham, UK

Sue Bayliss

Department of Public Health and Epidemiology, University of Birmingham, Birmingham, UK

Josie Sandercock

Department of Public Health and Epidemiology, University of Birmingham, Birmingham, UK

Traditionally, the management of bleeding trauma patients has included early rapid fluid replacement on scene. However, evidence shows that a delay to definitive treatment (control of bleeding) may be harmful and UK policy advocates minimal delay on scene with intravenous fluids being administered in transit to hospitals. This paper systematically reviews the evidence for administering fluids in pre-hospital trauma patients with no head injury. Randomized controlled trials comparing immediate and delayed fluid replacement were sought using formal search strategies. Study selection, quality assessment and data extraction were performed independently by two reviewers using pre-defined criteria. We found no evidence to suggest that pre-hospital fluid administration is beneficial. There is some evidence that it may be harmful and that patients do comparatively well when fluids are withheld. However, this evidence is not conclusive, particularly for blunt trauma, and is not sufficient to disprove current UK policy, which recommends hypotensive resuscitation.

Key Words: delayed fluid replacement • IV fluids • pre-hospital • systematic review • trauma

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