Understanding traumatic shock: Out-of-hospital hypotension with and without other physiologic compromise

Craig Newgard, Eric N. Meier, Barbara McKnight, Ian R. Drennan, Derek Richardson, Karen Brasel, Martin Schreiber, Jeffrey D. Kerby, Delores Kannas, Michael Austin, Eileen M. Bulger

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Among trauma patients with out-of-hospital hypotension, we evaluated the predictive value of systolic blood pressure (SBP) with and without other physiologic compromise for identifying trauma patients requiring early critical resources. Methods: Thiswas a secondary analysis of a prospective cohort of injured patients 13 years or older with out-of-hospital hypotension (SBP e 90mmHg) who were transported by 114emergencymedical service agencies to 56Level I and II traumacenters in 11 regions of the United States and Canada from January 1, 2010, through June 30, 2011. The primary outcome was early critical resource use, defined as blood transfusion of 6 U or greater, major nonorthopedic surgery, interventional radiology, or death within 24 hours. Results: of 3,337 injured patients with out-of-hospital hypotension, 1,094 (33%) required early critical resources and 1,334 (40%) had serious injury (Injury Severity Score [ISS] ≥ 16). Patients with isolated hypotension required less early critical resources (14% vs. 52%), had less serious injury (20% vs. 61%), and had lower mortality (24 hours, 1% vs. 26%; in-hospital, 3% vs. 34%). The standardized probability of requiring early critical resourceswas lowest among patients with blunt injury and isolated moderate hypotension (0.12; 95% confidence interval, 0.09-0.15) and steadily increased with additional physiologic compromise, more severe hypotension, and penetrating injury (0.94; 95% confidence interval, 0.90-0.98). Conclusion: A minority of trauma patients with isolated out-of-hospital hypotension require early critical resuscitation resources. However, hypotension accompanied by additional physiologic compromise or penetrating injury markedly increases the probability of requiring time-sensitive interventions. Level of Evidence: Prognostic study, level II.

Original languageEnglish (US)
Pages (from-to)342-351
Number of pages10
JournalJournal of Trauma and Acute Care Surgery
Volume78
Issue number2
DOIs
StatePublished - Feb 1 2015

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Traumatic Shock
Hypotension
Wounds and Injuries
Blood Pressure
Confidence Intervals
Interventional Radiology
Nonpenetrating Wounds
Injury Severity Score
Resuscitation
Blood Transfusion
Canada
Mortality

Keywords

  • Emergency medical services
  • Resuscitation
  • Shock

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Understanding traumatic shock : Out-of-hospital hypotension with and without other physiologic compromise. / Newgard, Craig; Meier, Eric N.; McKnight, Barbara; Drennan, Ian R.; Richardson, Derek; Brasel, Karen; Schreiber, Martin; Kerby, Jeffrey D.; Kannas, Delores; Austin, Michael; Bulger, Eileen M.

In: Journal of Trauma and Acute Care Surgery, Vol. 78, No. 2, 01.02.2015, p. 342-351.

Research output: Contribution to journalArticle

Newgard, Craig ; Meier, Eric N. ; McKnight, Barbara ; Drennan, Ian R. ; Richardson, Derek ; Brasel, Karen ; Schreiber, Martin ; Kerby, Jeffrey D. ; Kannas, Delores ; Austin, Michael ; Bulger, Eileen M. / Understanding traumatic shock : Out-of-hospital hypotension with and without other physiologic compromise. In: Journal of Trauma and Acute Care Surgery. 2015 ; Vol. 78, No. 2. pp. 342-351.
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AU - Richardson, Derek

AU - Brasel, Karen

AU - Schreiber, Martin

AU - Kerby, Jeffrey D.

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AB - Background: Among trauma patients with out-of-hospital hypotension, we evaluated the predictive value of systolic blood pressure (SBP) with and without other physiologic compromise for identifying trauma patients requiring early critical resources. Methods: Thiswas a secondary analysis of a prospective cohort of injured patients 13 years or older with out-of-hospital hypotension (SBP e 90mmHg) who were transported by 114emergencymedical service agencies to 56Level I and II traumacenters in 11 regions of the United States and Canada from January 1, 2010, through June 30, 2011. The primary outcome was early critical resource use, defined as blood transfusion of 6 U or greater, major nonorthopedic surgery, interventional radiology, or death within 24 hours. Results: of 3,337 injured patients with out-of-hospital hypotension, 1,094 (33%) required early critical resources and 1,334 (40%) had serious injury (Injury Severity Score [ISS] ≥ 16). Patients with isolated hypotension required less early critical resources (14% vs. 52%), had less serious injury (20% vs. 61%), and had lower mortality (24 hours, 1% vs. 26%; in-hospital, 3% vs. 34%). The standardized probability of requiring early critical resourceswas lowest among patients with blunt injury and isolated moderate hypotension (0.12; 95% confidence interval, 0.09-0.15) and steadily increased with additional physiologic compromise, more severe hypotension, and penetrating injury (0.94; 95% confidence interval, 0.90-0.98). Conclusion: A minority of trauma patients with isolated out-of-hospital hypotension require early critical resuscitation resources. However, hypotension accompanied by additional physiologic compromise or penetrating injury markedly increases the probability of requiring time-sensitive interventions. Level of Evidence: Prognostic study, level II.

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