Marqués Catalina González, Moretti Katelyn, Amanullah Siraj, Uwamahoro Chantal, Ndebwanimana Vincent, Garbern Stephanie, Naganathan Sonya, Martin Kyle, Niyomiza Joseph, Gjesvik Annie, Nkeshimana Menelas, Levine Adam C, Aluisio Adam R
Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, USA.
Department of Epidemiology and Pediatrics Brown University School of Public Health, Providence, USA.
Afr J Emerg Med. 2021 Mar;11(1):152-157. doi: 10.1016/j.afjem.2020.09.014. Epub 2020 Nov 5.
Injuries cause significant morbidity and mortality in sub-Saharan African countries such as Rwanda. These burdens may be compounded by limited access to intravenous (IV) resuscitation fluids such as crystalloids and blood products. This study evaluates the association between emergency department (ED) intravenous volume resuscitation and mortality outcomes in adult trauma patients treated at the University Teaching Hospital-Kigali (UTH- K).
Data were abstracted using a structured protocol for a random sample of ED patients treated during periods from 2012 to 2016. Patients under 15 years of age were excluded. Data collected included demographics, clinical aspects, types of IV fluid resuscitation provided and outcomes. The primary outcome was facility-based mortality. Descriptive statistics were used to explore characteristics of the population. Kampala Trauma Scores (KTS) were used to control for injury severity. Magnitudes of effects were quantified using multivariable regression models adjusted for gender, KTS, time period, clinical interventions, presence of head injury and transfer to a tertiary care centre to yield adjusted odds ratios (aOR) with 95% confidence intervals (CI).
From the random sample of 3609 cases, 991 trauma patients were analysed. The median age was 32 [IQR 26, 46] years and 74.3% were male. ED volume resuscitation was given to 50.1% of patients with 43.5% receiving crystalloid and 6.4% receiving crystalloid and packed red blood cell (PRBC) transfusions. The median KTS score was 13 [IQR 12, 13]. In multivariable regression, mortality likelihood was increased in those who received crystalloid (aOR = 4.31, 95%CI 1.24, 15.05, = 0.022) and PRBC plus crystalloid (aOR = 9.97, 95%CI 2.15,46.17, = 0.003) as compared to trauma patients not treated with IV resuscitation fluids
Injured ED patients treated with volume resuscitation had higher mortality, which may be due to unmeasured confounding or therapies provided. Further studies on fluid resuscitation in trauma populations in resource-limited settings are needed.
在卢旺达等撒哈拉以南非洲国家，伤害导致了显著的发病率和死亡率。获得静脉（IV）复苏液（如晶体液和血液制品）的机会有限可能会加重这些负担。本研究评估了基加利大学教学医院（UTH-K）治疗的成年创伤患者急诊科（ED）静脉容量复苏与死亡率之间的关联。
使用结构化方案从2012年至2016年期间治疗的ED患者随机样本中提取数据。排除15岁以下的患者。收集的数据包括人口统计学、临床情况、提供的IV液体复苏类型和结局。主要结局是基于机构的死亡率。使用描述性统计来探索人群特征。坎帕拉创伤评分（KTS）用于控制损伤严重程度。使用多变量回归模型对性别、KTS、时间段、临床干预、头部损伤的存在以及转至三级护理中心进行调整，以量化效应大小，得出调整后的比值比（aOR）及95%置信区间（CI）。
在3609例随机样本中，分析了991例创伤患者。中位年龄为32岁[四分位间距26, 46]，74.3%为男性。50.1%的患者接受了ED容量复苏，其中43.5%接受了晶体液，6.4%接受了晶体液和浓缩红细胞（PRBC）输血。中位KTS评分为13[四分位间距12, 13]。在多变量回归中，与未接受IV复苏液治疗的创伤患者相比，接受晶体液治疗者（aOR = 4.31，95%CI 1.24, 15.05，P = 0.022）和接受PRBC加晶体液治疗者（aOR = 9.97，95%CI 2.15, 46.17，P = 0.003）的死亡可能性增加。
接受容量复苏治疗的受伤ED患者死亡率较高，这可能是由于未测量的混杂因素或所提供的治疗所致。需要对资源有限环境中创伤人群的液体复苏进行进一步研究。
