Effect of age on the interaction between heart rate and mortality in prehospital trauma care

Objectives: The association between tachycardia and age in prehospital trauma mortality has not been thoroughly studied. The purpose of this study was to evaluate the interaction effects of age between prehospital tachycardia and mortality in adult trauma patients. Methods: Adult trauma patients during 2012, 2013, and 2015 who were treated and transported by emergency medical services (EMS) were analyzed. Main exposure was tachycardia (>90 beat/min) measured at the scene. The primary outcome was mortality, the secondary outcome was worsened disability. Multivariable logistic regression with interaction models between tachycardia and age was used to calculate the adjusted odds ratio (AOR) with 95% confidence intervals after adjusting for confounders. Results: A total of 35,542 patients were analyzed. Tachycardia had a significant association with mortality and worsened disability: 1.41 (1.28–1.54) for mortality and 1.25 (1.15–1.36) for worsened disability. In the interaction analysis, the AOR for mortality by tachycardia in age over 84 years was insignificant: 1.2 (1.11–1.3) for 15–64 years, 1.4 (1.29–1.52) for 65–84 years, 1.14 (0.92–1.42) for age over 85 years, respectively (p < 0.01 for interactions). Conclusion: Tachycardia had a significant association with mortality and worsened disability in prehospital trauma patients and age over 85 years old had a significantly different interaction effect. Prehospital trauma care protocol should include recognizing severe cases based on the patient’s heart rate and age. It would be helpful in the decision-making at the scene such as trauma center transfer and advanced treatment.

Intraosseous Specimens Submitted to the Laboratory: A Case Report and Review

ABSTRACT Intraosseous (IO) devices are used for vascular access in settings where venous access is initially unobtainable, such as prehospital trauma care or cardiac arrest. While IO devices are effective for infusion of blood, fluids, and medications, there is limited data on the analytical equivalence of specimens taken out of IO devices and peripheral venous blood. Despite this, IO device manufacturers and clinical resources state that IO specimens can be submitted for laboratory analysis. As reported in this case, IO specimens may be drawn and labeled as ‘peripheral blood’. IO specimens are not always caught by automated sample quality testing and may proceed through analysis without any warning signal to the laboratory. There are potential regulatory risks in accepting IO samples for analysis without validation. IO infusion is a valuable technique for vascular access in critically ill patients, but clinical laboratories will need to determine their own policies for identifying and handling IO specimens.

Fluid resuscitation in trauma: what are the best strategies and fluids?

Background Traumatic injuries pose a global health problem and account for about 10% global burden of disease. Among injured patients, the major cause of potentially preventable death is uncontrolled post-traumatic hemorrhage. Main body This review discusses the role of prehospital trauma care in low-resource/remote settings, goals, principles and evolving strategies of fluid resuscitation, ideal resuscitation fluid, and post-resuscitation fluid management. Management of fluid resuscitation in few special groups is also discussed. Conclusions Prehospital trauma care systems reduce mortality in low-resource/remote settings. Delayed resuscitation seems a better option when transport time to definitive care is shorter whereas goal-directed resuscitation with low-volume crystalloid seems a better option if transport time is longer. Few general recommendations regarding the choice of fluid are provided. Adhering to evidence-based clinical practice guidelines and local modifications based on patient population, available resources, and expertise will improve patient outcomes.