Is Field Hypotension a Reliable Indicator of Significant Injury in Trauma Patients who are Normotensive on Arrival to the Emergency Department?

Codner, Panna A.; Obaid, Amal; Porral, Diana; Lush, Stephanie; Cinat, Marianne

doi:10.1177/000313480507100915

Cited by 18 publications

(5 citation statements)

References 8 publications

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“…In comparison to patients in the normotensive group, patients who had hypotension in the field which resolved by time of arrival in the ED had significantly greater anatomic injury as demonstrated by doubling of ISS from a mean of 11.1 ± 9.5 to 22.0 ± 17.9. This data is also consistent with that of Codner and colleagues, 16 who found in a study of urban trauma patients with hypotension in the field that resolved prior to arrival at the ED that 51% of this population had a significant injury as defined by an ISS greater than 16, and 19% had a critical injury as defined by an ISS greater than 25. In our study 58% of the hypotensive group had an ISS of greater than 16, and 30% had an ISS of greater than 25.…”

Section: Discussionsupporting

confidence: 90%

“…In our study 58% of the hypotensive group had an ISS of greater than 16, and 30% had an ISS of greater than 25. In light of our findings and that of Codner et al 16 it is reasonable to assume that field hypotension is a marker of severe injury in both urban and rural environments. In earlier work by Chan et al, 17 patients with out-of-hospital hypotension were also associated with a higher ISS and greater number of femur and pelvic fractures than were patients who were not hypotensive in the field.…”

Section: Discussionsupporting

confidence: 73%

“…In this study hypotension was defined as a systolic BP of less than 90 mmHg and normotension as a systolic BP of greater or equal to 90 mmHg. While BP may vary according to the cardiovascular health of the patient and may be altered by antihypertensive medications, these values were chosen because the majority of studies 9,[11][12][13][14][15][16] investigating the effects of hypotension in adult populations use a range of 90-100 mmHg. In our study the mean field BP in the hypotensive group was 70 ± 26 mmHg which increased to 125 ± 22 mmHg by the time the patient arrived at the hospital.…”

Section: Discussionmentioning

confidence: 99%

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Field Hypotension in Patients Who Arrive at the Hospital Normotensive: A Marker of Severe Injury or Crying Wolf?

Schenarts

Phade

Agle

et al. 2008

North Carolina Medical Journal

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Introduction: Trauma patients with hypotension in the field who arrive at a hospital with a normal blood pressure (BP) may not be recognized as significantly injured.Methods: Over a 5-year period, demographic, injury severity, and disposition data were retrospectively analyzed for patients ≥16 years of age with documented hypotension in the field (systolic BP ≤ 90mmHg) and normal BP (systolic BP >90mmHg) on hospital arrival (hypotensive group). This group was compared to patients with normal BP in the field and on hospital arrival (normotensive group).Results: During the study, 2207 patients with documented BP were transported directly from the scene. Of this number 44 (2%) were assigned to the hypotensive group, 2086 (94%) were assigned to the normotensive group, and 77 (4%) patients were hypotensive on hospital arrival. The hypotensive group had a systolic BP in the field of 70 ± 26 mmHg compared to 140 ± 26 mmHg in the normotensive group (p<0.0001). Arrival BP at the hospital was normal in both groups. Compared to the normotensive group, the hypotensive group had higher Injury Severity Scores (22.0 vs 11.1, p<0.0001), lower Glasgow Coma Scores (10.8 vs14.0, p<0.0001), lower Revised Trauma Scores (6.5 vs 7.4, p<0.001), more emergency department deaths (7% vs 0%, p<0.001), longer lengths of stay in the intensive care unit (8.6 vs 7.0 days, p<0.0001) and hospital (14.0 vs 7.0 days, p<0.0001), and increased hospital mortality (18% vs 4%, p<0.001).Limitations: The retrospective design and exclusion of patients without documentation of BP in the field may have resulted in selection bias. Conclusion:Despite these limitations, field hypotension is a marker of significant injury in patients arriving at the hospital normotensive.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

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Field Hypotension in Patients Who Arrive at the Hospital Normotensive: A Marker of Severe Injury or Crying Wolf?

Schenarts

Phade

Agle

et al. 2008

North Carolina Medical Journal

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“…These conclusions are supported by previously published retrospective reviews. 3 5 Our study also supports the use of SBP ≤110 mm Hg as the definition for hypotension in patients with trauma.…”

Section: Discussionsupporting

confidence: 78%

Isolated prehospital hypotension correlates with injury severity and outcomes in patients with trauma

Damme

Luo

Buesing

2016

Trauma Surg Acute Care Open

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Objective Patients normotensive in the trauma bay despite documented prehospital hypotension may not be recognized as significantly injured. The purpose of this study was to determine whether isolated prehospital hypotension portends poor outcomes and correlates with injury severity. Methods Prospective cohort study conducted at a level 1 university trauma center. The lowest recorded prehospital systolic blood pressure (SBP) and the first recorded SBP on hospital arrival were used to divide patients into either the normotensive (NP) or hypotensive (HP) group. Patients who failed to achieve normotension on hospital arrival were excluded. Hypotension was defined as SBP≤110 mmHg.

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“…[6][7][8] However, because less than half of hypotensive trauma patients will ultimately require emergent operative intervention, hypotension is a useful but nonspecific marker. 1,6,9 The objective of this study was to determine a set of parameters which are available within minutes of arrival to the trauma bay that predict the need for emergent surgery to control hemorrhage in hypotensive trauma patients.…”

mentioning

confidence: 99%

Early Predictors of the Need for Emergent Surgery to Control Hemorrhage in Hypotensive Trauma Patients

Kaiser

Ahearn

Nguyen

et al. 2009

The American Surgeon™

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Twenty-five to 30 per cent of hypotensive trauma patients require an emergent surgery, however, we have no reliable means to quickly determine that need. Our goal was to determine, via retrospective review, parameters available within minutes of arrival that predict the need for emergent surgery to control hemorrhage in hypotensive trauma patients. Inclusion criterion was initial systolic blood pressure (SBP) < 90 mm Hg in the emergency department (ED). Patients who were dead on arrival or underwent ED thoracotomy were excluded. Emergent surgery was defined as sternotomy, thoracotomy, laparotomy, or major neck vascular repair on day of admission. Potential clinical predictors were analyzed in a binary logistic regression model. Six hundred and thirty-nine hypotensive patients were identified and 193 excluded, leaving 446 with a mean age of 33 ± 19 years and Injury Severity Score of 22 ± 17. Thirty-two per cent suffered penetrating trauma, 30 per cent needed emergent surgery, and 19 per cent died. Independent predictors were: prolonged extrication (odds ratio (OR) 2.3), no loss of consciousness (OR 2.8), intubation (OR 1.7), central line placement (OR 1.7), and blood transfusion (OR 2.1, all P < 0.05). We concluded that hypotensive trauma patients without head injuries who require prolonged extrication, intubation, central venous access, and blood transfusion in the ED are more likely to need emergent surgery.

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Is Field Hypotension a Reliable Indicator of Significant Injury in Trauma Patients who are Normotensive on Arrival to the Emergency Department?

Cited by 18 publications

References 8 publications

Field Hypotension in Patients Who Arrive at the Hospital Normotensive: A Marker of Severe Injury or Crying Wolf?

Field Hypotension in Patients Who Arrive at the Hospital Normotensive: A Marker of Severe Injury or Crying Wolf?

Isolated prehospital hypotension correlates with injury severity and outcomes in patients with trauma

Early Predictors of the Need for Emergent Surgery to Control Hemorrhage in Hypotensive Trauma Patients

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