Abstract 5: Prehospital Hypotension Is Associated with Emergent In-Hospital Procedures and Mortality in Trauma Patients

Abstract

Background: Prehospital vital signs are the basis of many triage and transport guidelines. They serve to activate prehospital and in-hospital trauma systems, and to direct prehospital and in-hospital resuscitation efforts and other interventions. Objective: The purpose of this study was to determine the relationship of prehospital systolic blood pressure with emergent in-hospital procedures and mortality. Methods: Included in this secondary analysis of the Resuscitation Outcomes Consortium (ROC) Hypertonic Saline Clinical Trial are patients 15 years or older who were enrolled in the study shock cohort. These patients had traumatic injury and a systolic blood pressure (SBP) ≤70 mm Hg or 71 - 90 mm Hg and a heart rate ≥108 beats/min. Emergent in-hospital procedures are defined as any blood transfusion, thoracotomy, laparotomy, craniotomy, neck exploration, or angiographic control of hemorrhage within 24 hours of emergency department admission or death within 6 hours of admission. We estimated between-group differences for mortality and the likelihood of emergent procedures for lowest SBP categories of <55, 55-64, 65-74, 75-84, and 85-90 (reference) mm Hg using a multiple logistic regression model adjusted for age, sex, Glasgow Coma Scale score, heart rate, penetrating trauma, prehospital advanced airway attempt, and ROC site. Results: From May 2006 to August 2008, 853 patients were enrolled, 38 were excluded for incomplete data, and 815 form the analyzable cohort. Mean age was 37 years and 78% were male. Mean (±SD) injury severity score was 24±16, 40% required a prehospital advanced airway, 73% required an emergent procedure, and overall mortality was 26%. We observed a significant relationship between lowest prehospital SBP and in-hospital emergent procedures and mortality (Table). Conclusion: Prehospital hypotension is significantly associated with in-hospital emergent procedures and mortality, especially when SBP is less than 65 mm Hg.