![]() ![]() To prevent inclusion of patients with minor injuries, only patients with Abbreviated Injury Scale (AIS) scores of 3 or more, but those without distinctive pathologies such as burns, hanging, strangulation injuries, intoxication, or hypothermia/hyperthermia, were included in the analysis. The study period was from January 2008 to December 2014, a period during which data of injured patients brought to the hospital without prehospital infusion owing to limited ambulance services were collected. The present study was a retrospective analysis of trauma patients. We hypothesize that severe trauma patients have an early decrease in Hb levels after an injury even if they are not receiving fluids. The aim of this study was to evaluate the relationship between early changes in Hb levels after hospital arrival, severity of the trauma, and need for hemostasis in severe trauma patients not receiving fluids. In our institution, prehospital infusions were gradually allowed to be performed under the direction of a doctor from the second half of 2014 but in 2014, no trauma patients with infusions were treated at our hospital. 5 In Japan, until 2014, owing to restrictions imposed by the national legislation, certified prehospital emergency life-saving technicians were not allowed to administer intravenous fluids to hypotensive trauma patients. ![]() Other studies also included severe trauma patients with massive fluid resuscitation because of their hypotensive status, which may have resulted in lowered Hb levels. ![]() The effect of prehospital infusion may be minimal however, the dilution effect cannot be ignored. 3 4 The study subjects in these previous studies, however, received prehospital intravenous fluid administration. 3–6 Bruns et al reported that an early decrease in Hb levels can be associated with the severity of bleeding in trauma patients. Traditionally, it has been believed that blood component values require hours to equilibrate however, recent investigations regarding Hb levels at the time of hospital admission of severe trauma patients have reported that peripheral levels of Hb can be lowered even during the very early stages of trauma. Blood Hb levels, however, have not been considered to be a marker for severe bleeding in the early stages of trauma because of a long-held belief that the compensatory mechanism that replaces the loss of blood volume in the vascular system takes effect slowly. The testing kit for peripheral blood hemoglobin (blood Hb) level, however, is generally available at the patient’s bedside. Laboratory data such as base deficit or serum lactate levels are also parameters for insufficient peripheral perfusions due to hypovolemia, but these parameters are not always instantly available. These physiological parameters, however, are non-specific, and lowered SBP often manifests only in the very late stage of trauma. Several physiological signs, such as heart rate, systolic blood pressure (SBP), altered mental status, or clammy skin can appear soon after the trauma and help physicians identify patients with ongoing traumatic bleeding. 2 Early identification of bleeding sites for immediate surgical control is critical for severe trauma patients. 1 Trauma-related death, especially in younger patients, is a huge socioeconomic loss. ![]() Trauma is still the leading cause of high morbidity and mortality both in industrialized and low-income and middle-income nations. ![]()
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