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Severely injured patients who get IV fluids ahead of the emergency room are much more likely to die than those who don't because of the delay in transporting them, according to new Johns Hopkins-led research.

IV fluids are standard care for trauma patients in Maryland and elsewhere, though there isn't sufficient scientific evidence that it universally helps, says Dr. Elliott R. Haut, an associate professor of surgery, anesthesiology and critical care medicine in Hopkins' School of Medicine and the study's leader.

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The research, published online in the February issue of Annals of Surgery, could spark changes to the decades-old practice.

"Giving IV fluids to patients before they go to the hospital can delay transport," says Haut said in a statement. "Our study suggests it may be better to get patients to the hospital faster. Starting fluids takes time and the IV fluids may cause harm on top of the timing issue."

Haut came to a similar conclusion about cervical collars before transport, saying they may not be necessary for some trauma patients pre-hospital and could delay needed treatment.

Fluids are given immediately to trauma victims whose blood pressure has dropped sharply because of blood loss. The fluids quickly raise pressure and keep the body's systems working, which is especially helpful to those with traumatic brain injuries. But Haut says the fluids may make matters worse in patients whose low pressure temporarily stops bleeding.

Haut and his colleagues looked at data from 776,734 trauma patients in the American College of Surgeons' National Trauma Data Bank between 2001 and 2005. About half got fluids pre-hospital. Those who were shot or stabbed were 25 percent more likely to die and those with severe head injuries were 35 percent more likely to die.

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