Document Detail


Hypotension begins at 110 mm Hg: redefining "hypotension" with data.
MedLine Citation:
PMID:  17693826     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
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:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of trauma     Volume:  63     ISSN:  1529-8809     ISO Abbreviation:  J Trauma     Publication Date:  2007 Aug 
Date Detail:
Created Date:  2007-08-13     Completed Date:  2007-09-11     Revised Date:  2008-09-17    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  291-7; discussion 297-9     Citation Subset:  AIM; IM    
Affiliation:
U.S. Army Institute for Surgical Research, Fort Sam Houston, Texas 78234-6315, USA. brian.eastridge@amedd.army.mil
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MeSH Terms
Descriptor/Qualifier:
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:
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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