Injuries associated with hypotension after trauma: Is it always haemorrhage?

Michael Eichinger, Martin A. Schreiber, Elaine Cole, Christopher Aylwin

    Research output: Contribution to journalArticlepeer-review


    Introduction: Restricted fluid replacement strategy is one part of damage control resuscitation for patients with trauma haemorrhage. However, not all patients presenting with physiological symptoms suggestive of haemorrhage are bleeding. This descriptive study aims to compare demographics and injuries in adult and older trauma patients presenting to the Emergency Department with hypotension versus normotension. Methods: This was a retrospective, descriptive data analysis from a UK trauma registry. The records from one major trauma centre were analysed between 2014–2019, and every hypotensive (systolic blood pressure <90 mmHg) trauma patient investigated for injuries associated with hypotension. The hypotensive threshold for older patients was also adjusted to 110 mmHg for sub-cohort analysis. Results: 6245 trauma patients were included, of which 255 (4.1%) arrived hypotensive at the Emergency Department. Significant blood loss was identified in 32.2% of those cases. In 27.1%, multiple potential associations obscured the underlying mechanism for the hypotension but were more commonly associated with hypotension than with normotension. Over a third (37.5%) were ≥65 years old. Neurological injuries occurred more frequently in both older hypotensive groups than younger patients. Conclusions: This study sought to compare injuries of adult and older trauma patients to aid trauma teams with decision making. In severely injured hypotensive patients, significant blood loss was the principal association with hypotension. However, several factors can mimic bleeding in the hypotensive trauma patient, which should be carefully considered. A prospective study is needed to clarify the characteristics and causes of bleeding mimics.

    Original languageEnglish (US)
    StateAccepted/In press - 2022


    • bleeding mimics
    • geriatric
    • haemorrhage
    • hypotension
    • Trauma

    ASJC Scopus subject areas

    • Surgery
    • Emergency Medicine
    • Critical Care and Intensive Care Medicine


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