Prehospital hypotension redefined

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: ≤60, ≤70, ≤80, ≤90, ≤100, and ≤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.