Trauma mortality and systolic BP

Here’s some further evidence that a ‘lowish’ – as opposed to a low – systolic blood pressure is a reason to be vigilant in trauma. In this study, it was BP measurement in the ED (rather than pre-hospital) that was assessed:

Introduction: Non-invasive systolic blood pressure (SBP) measurement is often used in triaging trauma patients. Traditionally, SBP < 90 mmHg has represented the threshold for hypotension, but recent studies have suggested redefining hypotension as SBP < 110 mmHg. This study aims to examine the association of SBP with mortality in blunt trauma patients.
Methods: This is an analysis of prospectively recorded data from adult (≥16 years) blunt trauma patients. Included patients presented to hospitals belonging to the Trauma Audit and Research Network (TARN) between 2000 and 2009. The primary outcome was the association of SBP and mortality rates at 30 days. Multivariate logistic regression models were used to adjust for the influence of age, gender, Injury Severity Score (ISS) and Glasgow Coma Score (GCS) on mortality.

Results: 47,927 eligible patients presented to TARN hospitals during the study period. Sample demographics were: median age: 51.1 years (IQR=32.8–67.4); male 60% (n=28,694); median ISS 9 (IQR = 8–10); median GCS 15 (IQR = 15–15); and median SBP 135 mmHg (IQR = 120–152). We identified SBP < 110 mmHg as a cut off for hypotension, where a significant increase in mortality was observed. Mor- tality rates doubled at <100 mmHg, tripled at <90 mmHg and were 5- to 6-fold at <70 mmHg, irrespective of age.
Conclusion: We recommend triaging adult blunt trauma patients with a SBP < 110 mmHg to resuscitation areas within dedicated trauma units for close monitoring and appropriate management.

Systolic blood pressure below 110mmHg is associated with increased mortality in blunt major trauma patients: Multicentre cohort study
Resuscitation. 2011 Sep;82(9):1202-7

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