The effect of prehospital intravenous access in traumatic shock: a Japanese nationwide cohort study

Aim: We aimed to evaluate effect of prehospital intravenous (IV) access on mortality in traumatic shock using a large nationwide dataset. Methods: We used the Japan Trauma Data Bank to identify adults (>= 18 years) with a systolic blood pressure <90 mm Hg at the trauma scene and were directly transported to the hospital between 2010 and 2019. We compared patients who had prehospital IV access (IV (+)) or not (IV (-)), using propensity score-matched analysis, and 1:1 nearest-neighbor matching without replacement. Standardized mean difference was used to evaluate the match balance between the two matched groups; a standardized mean difference >0.1 was considered a significant imbalance. Primary outcome was 72-h mortality. Results: Propensity scores matching generated 479 pairs from 5,857 patients. No significant between group differences occurred in 72-h mortality (7.8 versus 8.8%; difference, -1.0%; 95% confidence interval [CI]: -2.5-4.5%), 28-day mortality (11.8 versus 11.3%; 95% CI: -4.6-3.6%), blood transfusion administration within 24 h (55.3 versus 49.1%; 95% CI: -0.1-12.6%), prehospital time (56.3 versus 53.0 min; 95% CI: -1.8-8.4 min), and cardiopulmonary arrest on hospital arrival (1.3 versus 1.3%; 95% CI: -1.4-1.4%). However, significantly higher systolic blood pressure on hospital arrival was found in the IV (+) than in the IV (+) group (104.6 versus 100.1 mm Hg; 95% CI: 0.3-8.7 mm Hg). Conclusion: We found no significant effect of establishing IV access in the prehospital setting on survival outcomes of patients with traumatic shock.