Prehospital Fluid Administration Not Linked to Mortality in Patients With Severe Burns: Study
Japan: Researchers have found in a new research that among patients with severe burns, prehospital fluid administration was not significantly associated with early or in-hospital mortality. The findings suggest that prehospital fluid administration did not demonstrate a significant survival benefit in this patient population.
The study, published in the journal Burns, was conducted by Seiya Kanou from the Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan, and colleagues. The researchers examined whether administering intravenous fluids before hospital arrival could improve survival among patients with extensive burns, given that fluid resuscitation is commonly used to support circulation and maintain organ perfusion following severe burn injuries.
Severe burns can cause substantial fluid loss, circulatory instability, and impaired blood supply to vital organs. Although early fluid resuscitation is widely used to address these complications, the benefits of initiating treatment before hospital arrival remain uncertain. The researchers therefore investigated the association between prehospital fluid administration and mortality outcomes using nationwide trauma registry data from Japan.
For the retrospective observational study, the team analysed data from the Japanese nationwide trauma registry collected between January 2019 and December 2023. The study included 884 patients transported directly from the scene of injury who met the criteria for severe burns. These were defined as burns affecting at least 20% of total body surface area (TBSA) in patients aged five years or older, or at least 10% in younger children.
The primary outcome was all-cause mortality within 48 hours of hospital arrival, while in-hospital mortality served as the secondary outcome. Researchers used multiple imputation to address missing data and applied propensity score-based inverse probability weighting and multivariable statistical models to account for potential confounding factors.
Key Findings of the Study
- Prehospital fluid administration: Of the 884 patients included, 94 (10.6%) received fluids before reaching the hospital, while 790 did not.
- Early mortality: Death within 48 hours occurred in 23.4% of patients who received prehospital fluids, compared with 13.4% of those who did not.
- In-hospital mortality: The proportion of patients who died during hospitalisation was 44.7% in the fluid administration group and 28.4% in the non-fluid group.
- Adjusted mortality outcomes: After accounting for potential confounding factors, prehospital fluid administration was not significantly associated with 48-hour mortality (odds ratio [OR], 0.88) or in-hospital mortality (OR, 1.30).
The findings indicate that prehospital fluid administration was not associated with a statistically significant reduction in early or overall hospital mortality among patients with severe burns. However, the observational design limits the ability to establish a causal relationship, and the relatively small number of patients receiving fluids may have reduced the study's statistical power.
The researchers noted that further studies, including randomised controlled trials, are needed to clarify whether prehospital fluid resuscitation improves survival in patients with severe burns. The current findings do not establish a clear survival advantage for either approach.
Reference:
Kanou, S., Nakahara, S., Chiba, H., Tsunoyama, T., Endo, T., Tomonaga, A., Takata, N., Hosaka, H., Okumura, H., & Suzuki, T. (2026). Prehospital Fluid Resuscitation in Patients with Severe Burns — A Nationwide Cohort Study. Burns, 108254. https://doi.org/10.1016/j.burns.2026.108254
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