Keita Shibahashi1, Kazuhiro Sugiyama2, Yoshihiro Okura2, Jun Tomio3, Hidenori Hoda2, Yuichi Hamabe2. 1. Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan. Electronic address: kshibahashi@yahoo.co.jp. 2. Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan. 3. Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Abstract
BACKGROUND: Hypotension, a risk factor for increased mortality following traumatic brain injury (TBI), is traditionally defined as systolic blood pressure (SBP) <90 mm Hg. We aimed to redefine hypotension and determine its optimal threshold in patients with TBI. METHODS: We identified patients with severe TBI (Glasgow Coma Scale score ≤8 on admission) between 2004 and 2015 using data from the Japan Trauma Data Bank. Our endpoint was in-hospital mortality. Mixed effects logistic regression models were used to investigate the association between SBP on admission and in-hospital mortality, with hospitals considered as a random effects variable. We also conducted analyses stratified by age (≤60 years and >60 years) to determine age-specific optimal levels of SBP. RESULTS: A total of 12,537 patients (5665 patients ≤60 years old and 6872 patients >60 years old) were eligible for the analyses. Overall, SBP of 110 mm Hg was the optimal threshold for hypotension, and adjusted odds ratio and C-statistic for mortality at SBP <110 mm Hg on admission were 1.58 (95% confidence interval, 1.42-1.76, P < 0.001) and 0.78 (95% confidence interval, 0.77-0.79), respectively. Stratified analyses showed that optimal thresholds for hypotension in patients ≤60 years old and >60 years old were 100 mm Hg and 120 mm Hg. CONCLUSIONS: The threshold for hypotension in patients with severe TBI should be redefined and modified by age, and patients ≤60 years old should be considered hypotensive at SBP <100 mm Hg, whereas in older patients, SBP <120 mm Hg should be diagnosed as hypotension.
BACKGROUND:Hypotension, a risk factor for increased mortality following traumatic brain injury (TBI), is traditionally defined as systolic blood pressure (SBP) <90 mm Hg. We aimed to redefine hypotension and determine its optimal threshold in patients with TBI. METHODS: We identified patients with severe TBI (Glasgow Coma Scale score ≤8 on admission) between 2004 and 2015 using data from the Japan Trauma Data Bank. Our endpoint was in-hospital mortality. Mixed effects logistic regression models were used to investigate the association between SBP on admission and in-hospital mortality, with hospitals considered as a random effects variable. We also conducted analyses stratified by age (≤60 years and >60 years) to determine age-specific optimal levels of SBP. RESULTS: A total of 12,537 patients (5665 patients ≤60 years old and 6872 patients >60 years old) were eligible for the analyses. Overall, SBP of 110 mm Hg was the optimal threshold for hypotension, and adjusted odds ratio and C-statistic for mortality at SBP <110 mm Hg on admission were 1.58 (95% confidence interval, 1.42-1.76, P < 0.001) and 0.78 (95% confidence interval, 0.77-0.79), respectively. Stratified analyses showed that optimal thresholds for hypotension in patients ≤60 years old and >60 years old were 100 mm Hg and 120 mm Hg. CONCLUSIONS: The threshold for hypotension in patients with severe TBI should be redefined and modified by age, and patients ≤60 years old should be considered hypotensive at SBP <100 mm Hg, whereas in older patients, SBP <120 mm Hg should be diagnosed as hypotension.
Authors: Camilo Toro; Tetsu Ohnuma; Jordan Komisarow; Monica S Vavilala; Daniel T Laskowitz; Michael L James; Joseph P Mathew; Adrian F Hernandez; Ben A Goldstein; John H Sampson; Vijay Krishnamoorthy Journal: Anesth Analg Date: 2022-02-17 Impact factor: 6.627
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