Prehospital hypotension redefined.

Brandon Bruns, Larry Gentilello, Alan Elliott, Shahid Shafi

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)1217-1221
Number of pages5
JournalThe Journal of trauma
Volume65
Issue number6
StatePublished - Dec 2008

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Hypotension
Blood Pressure
Trauma Centers
Triage
Hospital Emergency Service
Advanced Trauma Life Support Care
Nonpenetrating Wounds
Registries
Shock

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Bruns, B., Gentilello, L., Elliott, A., & Shafi, S. (2008). Prehospital hypotension redefined. The Journal of trauma, 65(6), 1217-1221.

Prehospital hypotension redefined. / Bruns, Brandon; Gentilello, Larry; Elliott, Alan; Shafi, Shahid.

In: The Journal of trauma, Vol. 65, No. 6, 12.2008, p. 1217-1221.

Research output: Contribution to journalArticle

Bruns, B, Gentilello, L, Elliott, A & Shafi, S 2008, 'Prehospital hypotension redefined.', The Journal of trauma, vol. 65, no. 6, pp. 1217-1221.
Bruns B, Gentilello L, Elliott A, Shafi S. Prehospital hypotension redefined. The Journal of trauma. 2008 Dec;65(6):1217-1221.
Bruns, Brandon ; Gentilello, Larry ; Elliott, Alan ; Shafi, Shahid. / Prehospital hypotension redefined. In: The Journal of trauma. 2008 ; Vol. 65, No. 6. pp. 1217-1221.
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