Abstract
BackgroundSystolic blood pressure (SBP) and shock index (SI) are accurate indicators of hemodynamic instability and the need for transfusion in trauma patients. We aimed to determine whether the utility and cutoff point for SBP and SI are affected by age and antihypertensives.MethodsThis was a retrospective observational study of a level 1 trauma center between January 2017 and December 2018. We analyzed the utility and cutoff points of SBP and SI for predicting massive transfusion (MT) and 30-day mortality according to patients’ age and whether they were taking antihypertensives. A multivariable logistic regression analysis was conducted to estimate the association of age and antihypertensives on primary and secondary outcomes.ResultsWe analyzed 4681 trauma cases. There were 1949 patients aged 65 years or older (41.6%), and 1375 hypertensive patients (29.4%). MT was given to 137 patients (2.9%). The 30-day mortality rate was 6.3% (n = 294). In geriatric trauma patients taking antihypertensives, a prehospital SBP less than 110 mmHg was the cutoff value for predicting MT in multivariate logistic regression analyses; packed red blood cell transfusion volume decreased abruptly based on prehospital SBP of 110 mmHg. Emergency Department SI greater than 1.0 was the cutoff value for predicting MT in patients who were older than 65 years and were not taking antihypertensives.ConclusionsThe triage of trauma patients is based on the identification of clinical features readily identifiable by first responders. However, age and medications may also affect the accurate evaluation. In initial trauma management, we must apply SBP and SI differently depending on age, whether a patient is taking antihypertensives, and the time at which the indicators are measured.
Highlights
Systolic blood pressure (SBP) and shock index (SI) are accurate indicators of hemodynamic instability and the need for transfusion in trauma patients
The low physiological capacity in geriatric patients masks the clinical exacerbation of injury, which makes the management of these patients more difficult [6]
We included patients who were admitted to the hospital after trauma who were 15 years old or older, and had a measurement of SBP and heart rate (HR) taken at the injury scene and in the emergency department (ED)
Summary
Systolic blood pressure (SBP) and shock index (SI) are accurate indicators of hemodynamic instability and the need for transfusion in trauma patients. Older age is associated with higher rates of morbidity and mortality after injury as aging and the presence of comorbidities reduce physiological reserves [2, 3]. A very low Glasgow Coma Scale (GCS) score and systolic blood pressure (SBP) of less than 80 mmHg are potential clinical indicators of massive bleeding and traumatic brain injury [4]. The assessment of injury severity and hemodynamic instability in geriatric patients is often difficult because of their altered response to injury [1, 5]. The low physiological capacity in geriatric patients masks the clinical exacerbation of injury, which makes the management of these patients more difficult [6]
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