| Hypotension begins at 110 mm Hg: redefining "hypotension" with data. | |
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MedLine Citation:
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PMID: 17693826 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Clinicians routinely refer to hypotension as a systolic blood pressure (SBP) < or =90 mm Hg. However, few data exist to support the rigid adherence to this arbitrary cutoff. We hypothesized that the physiologic hypoperfusion and mortality outcomes classically associated with hypotension were manifest at higher SBPs. METHODS: A total of 870,634 patient records from the National Trauma Data Bank with emergency department SBP and mortality data were analyzed. Patients (140,898) with severe head injuries, a Glasgow Coma Score < or =8, and base deficit (BD) <5, or missing data items were excluded from analysis. Admission BD, as a measure of metabolic hypoperfusion, was evaluated in 81,134 patients and mortality was plotted against SBP. RESULTS: Baseline mortality was <2.5%. However, at 110 mm Hg, the slope of the mortality curve increased such that mortality was 4.8% greater for every 10-mm Hg decrement in SBP. This effect was consistent to a maximum of 26% mortality at a SBP of 60 mm Hg. Hypoperfusion (change in the slope of BD curve) began to increase above baseline of 4.5 at a SBP 118 mm Hg. CONCLUSION: Taking the BD and mortality measurements together, this analysis shows that a SBP < or =110 mm Hg is a more clinically relevant definition of hypotension and hypoperfusion than is 90 mm Hg. This analysis will also be useful for developing appropriately powered studies of hemorrhagic shock. |
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Authors:
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Brian J Eastridge; Jose Salinas; John G McManus; Lorne Blackburn; Eileen M Bugler; William H Cooke; Victor A Convertino; Victor A Concertino; Charles E Wade; John B Holcomb |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The Journal of trauma Volume: 63 ISSN: 1529-8809 ISO Abbreviation: J Trauma Publication Date: 2007 Aug |
Date Detail:
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Created Date: 2007-08-13 Completed Date: 2007-09-11 Revised Date: 2008-09-17 |
Medline Journal Info:
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Nlm Unique ID: 0376373 Medline TA: J Trauma Country: United States |
Other Details:
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Languages: eng Pagination: 291-7; discussion 297-9 Citation Subset: AIM; IM |
Affiliation:
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U.S. Army Institute for Surgical Research, Fort Sam Houston, Texas 78234-6315, USA. brian.eastridge@amedd.army.mil |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Age Factors Aged Aged, 80 and over Blood Pressure Determination Cause of Death* Critical Care Critical Illness Female Glasgow Coma Scale Hospital Mortality / trends* Humans Hypotension / classification*, diagnosis, mortality* Injury Severity Score Male Middle Aged ROC Curve Registries Retrospective Studies Risk Assessment Sensitivity and Specificity Systole / physiology Wounds and Injuries / mortality*, physiopathology |
| Comments/Corrections | |
Erratum In:
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J Trauma. 2008 Aug;65(2):501 Note: Concertino, Victor A [corrected to Convertino, Victor A] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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