Prehospital Hypotension is a Predictor of the Need for an Emergent, Therapeutic Operation in Trauma Patients With Normal Systolic Blood Pressure in the Emergency Department: Lipsky AM, Gausche-Hill M, Henneman PL, et al. J Trauma 2006;61:1228–33

Abstract

The focus of the study was to ascertain the extent by which prehospital hypotension would indicate the need for emergent surgical intervention in trauma patients who had normal blood pressures in the emergency department (ED). This prospective, observational, cohort study, conducted at Harbor-UCLA Medical Center, evaluated 1028 trauma patients meeting Los Angeles County trauma criteria and who also were normotensive (systolic blood pressure > 90 mm Hg in adults, > 2 × [age in years] + 70 mm Hg in children < 10 years old, or who had palpable pulses) in the ED. Of the 1028 patients, 71 (7%) were hypotensive in the field and three times more likely to receive an emergent operation when compared to the normotensive prehospital group (odds ratio [OR] 4.5, 95% confidence interval [CI] 2.7–7.6). The prehospital hypotensive group also demonstrated an increased overall mortality (OR 2.3, 95% CI 0.8–6.9). Blunt and penetrating traumas with prehospital hypotension were both 2.5 times more likely to have an emergent surgery (OR 3.3, 95% CI 1.5–7.2 and OR 4.9, 95% CI 2.2–10.7, respectively). The ED disposition of trauma patients was statistically significant (p = 0.04) with a greater percentage of prehospital hypotensive patients being admitted to the hospital and in higher level of care. The authors concluded that prehospital hypotension is strongly predictive of therapeutic, emergent surgery in trauma patients with normal blood pressures in the ED.