An analysis of radial pulse strength to recorded blood pressure in the Department of Defense Trauma Registry.

Abstract

Hemorrhage is the leading cause of potentially preventable death on the battlefield. The tactical combat casualty care guidelines recommend the use of the radial pulse strength to guide the administration of blood products or intravenous fluids when equipment for blood pressure monitoring is not available. Data supporting this measurement tool are limited. We sought to validate this method in a deployed trauma population. This is a secondary analysis of a previously published dataset from the Department of Defense Trauma Registry. In this subanalysis, we focused on emergency department radial pulse strength documented in conjunction with systolic blood pressure readings. Our predefined search codes captured 28,222 Department of Defense Trauma Registry casualties. Of those, 22,192 casualties had at least 1 radial pulse strength documented, with a total of 27,366 documented measurements total among the 22,192. The median age of casualties was 25years, most were male (96.8%), U.S. military made up the largest proportion (44.2%), most were injured by explosive (55.8%), and most were in Afghanistan (67.0%) with a median injury severity score of 9. Mean systolic blood pressures were significantly different based on radial pulse strength: strong (129.6), weak (107.5), and absent (85.1). However, when using a binary threshold of 80mmHg, there were 615 documented instances of hypotension. Within that 615, 55.6% had a strong radial pulse, 29.3% had a weak radial pulse, and 15.1% had an absent radial pulse (P<.001). Although mean systolic blood pressure was associated with radial pulse quality, when using a binary measurement of hypotension (systolic < 80mmHg) characterization of the radial pulse was not a reliable indicator of hypotension. Better methods for casualty monitoring must be employed to avoid missing opportunities for intervention.