BACKGROUND: Systolic blood pressure is used extensively to triage trauma patients as stable or unstable, contrary to Advanced Trauma Life Support recommendations. We hypothesized that systemic hypotension is a late marker of shock. METHODS: The National Trauma Data Bank was queried (n = 115,830). Base deficit was used as a measure of circulatory shock. Systolic blood pressure was correlated with the presence and the severity of base-deficit derangement. RESULTS: Systolic blood pressure correlated poorly with base deficit (r = .28). There was wide variation in systolic blood pressure within each base-deficit group. The mean and median systolic blood pressure did not decrease to less than 90 mm Hg until the base deficit was worse than -20, with mortality reaching 65%. CONCLUSIONS: We validated the Advanced Trauma Life Support principle that systemic hypotension is a late marker of shock. A normal blood pressure should not deter aggressive evaluation and resuscitation of trauma patients.
BACKGROUND: Systolic blood pressure is used extensively to triage traumapatients as stable or unstable, contrary to Advanced Trauma Life Support recommendations. We hypothesized that systemic hypotension is a late marker of shock. METHODS: The National Trauma Data Bank was queried (n = 115,830). Base deficit was used as a measure of circulatory shock. Systolic blood pressure was correlated with the presence and the severity of base-deficit derangement. RESULTS: Systolic blood pressure correlated poorly with base deficit (r = .28). There was wide variation in systolic blood pressure within each base-deficit group. The mean and median systolic blood pressure did not decrease to less than 90 mm Hg until the base deficit was worse than -20, with mortality reaching 65%. CONCLUSIONS: We validated the Advanced Trauma Life Support principle that systemic hypotension is a late marker of shock. A normal blood pressure should not deter aggressive evaluation and resuscitation of traumapatients.
Authors: Adam E Porter; Elizabeth A Rozanski; Claire R Sharp; Kursten L Dixon; Lori Lyn Price; Scott P Shaw Journal: J Vet Emerg Crit Care (San Antonio) Date: 2013-07-15
Authors: Mohammad A Khasawneh; Martin D Zielinski; Donald H Jenkins; Scott P Zietlow; Henry J Schiller; Mariela Rivera Journal: World J Surg Date: 2014-08 Impact factor: 3.352