Resuscitation volume in paediatric non-haemorrhagic blunt trauma

IntroductionTrauma is a major cause of paediatric morbidity and mortality, yet knowledge of fluid resuscitation is limited. Our objectives were to determine current practises in resuscitation volume (RV) administered to paediatric non-haemorrhagic (NH) blunt trauma patients and to identify fluid related complications.MethodsWe examined data from 139 trauma patients 1–17 years of age with an injury severity score ≥12 resuscitated at a Trauma-designated Children's Hospital. Patients were separated into discreet groups based on ATLS age-dependent vital functions: toddler/preschooler (1–5 years), school age (6–12 years) and adolescent (13–17 years).ResultsThe median RV (total fluid intake − maintenance fluid intake) in ml/kg over the first 24 h from the time of trauma by age was: 24 (IQR = 19–47; 1–5 years); 26 (IQR = 15–36; 6–12 years); and 22 (IQR = 14–42; 13–17 years). The differences in RV/kg/24 h following NH trauma was not significantly different between age groups (p = 0.41). Urine output over the 24 h ranged from 2.5 (IQR = 1.9–3.3; lower age group) to 1.8 (IQR = 1.2–2.4; upper age group) ml/kg/h; greater than the ATLS recommended age-dependent targets. Haematocrit was the only significant independent predictor of RV/kg/24 h (p < 0.001). Fluid-related complications attributable to RV were identified in 12% (n = 17/139) of patients, and included ascites (8%; n = 11/139) and/or pleural effusion(s) (9%; n = 13/139). Patients with fluid-related complications received significantly more RV in ml/kg/24 h (42, IQR = 27–76) than those without complications (22, IQR = 14–36; p = 0.001).ConclusionsThe range of median RV administered to paediatric NH blunt trauma patients with ISS ≥ 12 was 22–26 ml/kg/24 h. The RV administered was excessive based on high urine outputs and the presence of fluid-related complications. Further evaluation of RV triggers and endpoints used by paediatric traumatologists is required.