TY - JOUR
T1 - Redefining hypotension in traumatic brain injury
AU - Berry, Cherisse
AU - Ley, Eric J.
AU - Bukur, Marko
AU - Malinoski, Darren
AU - Margulies, Daniel R.
AU - Mirocha, James
AU - Salim, Ali
PY - 2012/11
Y1 - 2012/11
N2 - 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.
AB - 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.
KW - Hypotension
KW - Mortality
KW - Traumatic brain injury
UR - http://www.scopus.com/inward/record.url?scp=84866740892&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84866740892&partnerID=8YFLogxK
U2 - 10.1016/j.injury.2011.08.014
DO - 10.1016/j.injury.2011.08.014
M3 - Article
C2 - 21939970
AN - SCOPUS:84866740892
SN - 0020-1383
VL - 43
SP - 1833
EP - 1837
JO - Injury
JF - Injury
IS - 11
ER -