Clinical Outcomes Associated With Intravenous Fluid Shortages in Emergency Department Patients: A Propensity Score Matched Cohort Study
Abstract
Background Intravenous (IV) saline is critical for emergency department (ED) care, supporting resuscitation, rehydration, and electrolyte correction. National IV fluid shortages, including the shortage following Hurricane Helene in September 2024, may disrupt timely care, yet large-scale evidence on associated clinical outcomes is limited. Methods In this retrospective observational cohort study using the TriNetX global federated electronic health record network, adult ED patients aged 18-65 years presenting during a nationwide IV fluid shortage (October 2024-May 2025) were compared with those presenting during a prior period of adequate supply. Cohorts were propensity score matched on demographics and comorbidities. Time-to-event outcomes within 7 days were analyzed using Cox proportional hazards models. Results After matching, 2,767,318 patients were included in each cohort. Compared with the non-shortage period, ED visits during the shortage were associated with small but consistent increases in rates of sepsis (HR 1.066), gastroenteritis (HR 1.151), acute kidney failure (HR 1.006), and hyponatremia (HR 1.074). Fluid administration was reduced (HR 0.869), consistent with expectations during the shortage period. Hospitalization (HR 1.06) was more frequent, while mortality did not differ. Conclusion Nationwide IV fluid shortages were associated with mild increases in acute complications and healthcare utilization among ED patients without increased short-term mortality. These findings underscore the need for preparedness strategies to mitigate the clinical impact of future IV fluid supply disruptions. Effect sizes were modest, and while statistically significant, they likely represent small individual level clinical differences. Given the large number of ED encounters affected, these patterns may reflect broader health-system strain during the nationwide shortage.
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BibTeX
@article{patel2026clinical,
title = {{Clinical Outcomes Associated With Intravenous Fluid Shortages in Emergency Department Patients: A Propensity Score Matched Cohort Study}},
author = {Milan Patel BS and Ahmed M. Afifi MD and Gabriel G. Bonassi BS and Ali A. Fakih BS and Mohamad Moussa MD and Stephen Grider DO, FACEP, FACOEP},
journal = {Health Services Insights},
year = {2026},
month = oct,
doi = {10.1177/11786329261502448},
url = {https://doi.org/10.1177/11786329261502448},
note = {CC BY},
}
RIS
TY - JOUR
TI - Clinical Outcomes Associated With Intravenous Fluid Shortages in Emergency Department Patients: A Propensity Score Matched Cohort Study
AU - Milan Patel BS
AU - Ahmed M. Afifi MD
AU - Gabriel G. Bonassi BS
AU - Ali A. Fakih BS
AU - Mohamad Moussa MD
AU - Stephen Grider DO, FACEP, FACOEP
PY - 2026
DA - 2026/10/27
JO - Health Services Insights
DO - 10.1177/11786329261502448
UR - https://doi.org/10.1177/11786329261502448
AB - Background Intravenous (IV) saline is critical for emergency department (ED) care, supporting resuscitation, rehydration, and electrolyte correction. National IV fluid shortages, including the shortage following Hurricane Helene in September 2024, may disrupt timely care, yet large-scale evidence on associated clinical outcomes is limited. Methods In this retrospective observational cohort study using the TriNetX global federated electronic health record network, adult ED patients aged 18-65 years presenting during a nationwide IV fluid shortage (October 2024-May 2025) were compared with those presenting during a prior period of adequate supply. Cohorts were propensity score matched on demographics and comorbidities. Time-to-event outcomes within 7 days were analyzed using Cox proportional hazards models. Results After matching, 2,767,318 patients were included in each cohort. Compared with the non-shortage period, ED visits during the shortage were associated with small but consistent increases in rates of sepsis (HR 1.066), gastroenteritis (HR 1.151), acute kidney failure (HR 1.006), and hyponatremia (HR 1.074). Fluid administration was reduced (HR 0.869), consistent with expectations during the shortage period. Hospitalization (HR 1.06) was more frequent, while mortality did not differ. Conclusion Nationwide IV fluid shortages were associated with mild increases in acute complications and healthcare utilization among ED patients without increased short-term mortality. These findings underscore the need for preparedness strategies to mitigate the clinical impact of future IV fluid supply disruptions. Effect sizes were modest, and while statistically significant, they likely represent small individual level clinical differences. Given the large number of ED encounters affected, these patterns may reflect broader health-system strain during the nationwide shortage.
SN - 1178-6329
ER -