Brandon Bruns1, Larry Gentilello, Alan Elliott, Shahid Shafi. 1. Department of Surgery, Division of Burns, Trauma, and Critical Care, University of Texas Southwestern Medical School, Parkland Memorial Hospital, Dallas, Texas, USA.
Abstract
BACKGROUND: The American College of Surgeons Committee on Trauma suggests prehospital systolic blood pressure (PSBP) < 90 mm Hg as a criterion for triage of injured patients to trauma centers. However, Advanced Trauma Life Support recognizes this threshold as a late sign of shock. We undertook the current study to determine whether a higher PSBP threshold may identify patients at significant risk of death. METHODS: A retrospective analysis of an urban, Level I trauma center registry data was undertaken in patients with complete information on PSBP (n = 16,365; 1994-2003). Several thresholds of PSBP were chosen: < or = 60, < or = 70, < or = 80, < or = 90, < or = 100, and < or = 110 mm Hg, and the relationship between each threshold of PSBP and patient outcomes was explored. A p value < 0.05 was considered statistically significant. RESULTS: Mean age of patients was 36 +/- 16 years, and 81% sustained a blunt injury. PSBP strongly correlated with systolic blood pressure obtained in the emergency department (Pearson r 0.65, p < 0.001). The risk of death increased sharply when PSBP dropped < 110 mm Hg, with nearly 1 in 10 (8%) dying in the emergency department and one in six (15%) dying eventually. CONCLUSIONS: The definition of prehospital hypotension used for triage of injured patients to trauma centers should be redefined as PSBP < 110 mm Hg. The impact of this redefinition on trauma center resource utilization should be studied further.
BACKGROUND: The American College of Surgeons Committee on Trauma suggests prehospital systolic blood pressure (PSBP) < 90 mm Hg as a criterion for triage of injured patients to trauma centers. However, Advanced Trauma Life Support recognizes this threshold as a late sign of shock. We undertook the current study to determine whether a higher PSBP threshold may identify patients at significant risk of death. METHODS: A retrospective analysis of an urban, Level I trauma center registry data was undertaken in patients with complete information on PSBP (n = 16,365; 1994-2003). Several thresholds of PSBP were chosen: < or = 60, < or = 70, < or = 80, < or = 90, < or = 100, and < or = 110 mm Hg, and the relationship between each threshold of PSBP and patient outcomes was explored. A p value < 0.05 was considered statistically significant. RESULTS: Mean age of patients was 36 +/- 16 years, and 81% sustained a blunt injury. PSBP strongly correlated with systolic blood pressure obtained in the emergency department (Pearson r 0.65, p < 0.001). The risk of death increased sharply when PSBP dropped < 110 mm Hg, with nearly 1 in 10 (8%) dying in the emergency department and one in six (15%) dying eventually. CONCLUSIONS: The definition of prehospital hypotension used for triage of injured patients to trauma centers should be redefined as PSBP < 110 mm Hg. The impact of this redefinition on trauma center resource utilization should be studied further.
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