Redefining hypotension in traumatic brain injury

Cherisse Berry, Eric J. Ley, Marko Bukur, Darren Malinoski, Daniel R. Margulies, James Mirocha, Ali Salim

    Research output: Contribution to journalArticle

    57 Scopus citations

    Abstract

    Background: Systemic hypotension is a well documented predictor of increased mortality following traumatic brain injury (TBI). Hypotension is traditionally defined as systolic blood pressure (SBP) < 90 mm Hg. Recent evidence defines hypotension by a higher SBP in injured (non-TBI) trauma patients. We hypothesize that hypotension threshold requires a higher SBP in isolated moderate to severe TBI. Patients and methods: A retrospective database review of all adults (≥15 years) with isolated moderate to severe TBI (head abbreviated injury score (AIS) ≥ 3, all other AIS ≤ 3), admitted from five Level I and eight Level II trauma centres (Los Angeles County), between 1998 and 2005. Several fit statistic analyses were performed for each admission SBP from 60 to 180 mm Hg to identify the model that most accurately defined hypotension for three age groups: 15-49 years, 50-69 years, and ≥70 years. The main outcome variable was mortality, and the optimal definition of hypotension for each group was determined from the best fit model. Adjusted odds ratios (AOR) were then calculated to determine increased odds in mortality for the defined optimal SBP within each age group. Results: A total of 15,733 patients were analysed. The optimal threshold of hypotension according to the best fit model was SBP of 110 mm Hg for patients 15-49 years (AOR 1.98, CI 1.65-2.39, p < 0.0001), 100 mm Hg for patients 50-69 years (AOR 2.20, CI 1.46-3.31, p = 0.0002), and 110 mm Hg for patients ≥70 years (AOR 1.92, CI 1.35-2.74, p = 0.0003). Conclusions: Patients with isolated moderate to severe TBI should be considered hypotensive for SBP < 110 mm Hg. Further research should confirm this new definition of hypotension by correlation with indices of perfusion.

    Original languageEnglish (US)
    Pages (from-to)1833-1837
    Number of pages5
    JournalInjury
    Volume43
    Issue number11
    DOIs
    StatePublished - Nov 2012

    Keywords

    • Hypotension
    • Mortality
    • Traumatic brain injury

    ASJC Scopus subject areas

    • Emergency Medicine
    • Orthopedics and Sports Medicine

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    Berry, C., Ley, E. J., Bukur, M., Malinoski, D., Margulies, D. R., Mirocha, J., & Salim, A. (2012). Redefining hypotension in traumatic brain injury. Injury, 43(11), 1833-1837. https://doi.org/10.1016/j.injury.2011.08.014