Document Detail


Prehospital systolic blood pressure thresholds: a community-based outcomes study.
MedLine Citation:
PMID:  23758307     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Emergency medical services (EMS) personnel commonly use systolic blood pressure (sBP) to triage and treat acutely ill patients. The definition of prehospital hypotension and its associated outcomes are poorly defined. The authors sought to determine the discrimination of prehospital sBP thresholds for 30-day mortality and to compare patient classification by best-performing thresholds to traditional cutoffs.
METHODS: In a community-based cohort of adult, nontrauma, noncardiac arrest patients transported by EMS between 2002 and 2006, entries to state hospital discharge data and death certificates were linked. Prehospital sBP thresholds between 40 and 140 mm Hg in derivation (n = 132,624) and validation (n = 22,020) cohorts and their discrimination for 30-day mortality, were examined. Cutoffs were evaluated using the 0/1 distance, Youden index, and adjusted Z-statistics from multivariable logistic regression models.
RESULTS: In the derivation cohort, 1,594 (1.2%) died within 24 hours, 7,404 (6%) were critically ill during hospitalization, and 6,888 (5%) died within 30 days. The area under the receiver operating characteristic (ROC) curve for sBP was 0.60 (95% confidence interval [CI] = 0.59, 0.61) for 30-day mortality and 0.64 (95% CI = 0.62 0.66) for 24-hour mortality. The 0/1 distance, Youden index, and adjusted Z-statistics found best-performing sBP thresholds between 110 and 120 mm Hg. When compared to an sBP ≤ 90 mm Hg, a cutoff of 110 mm Hg would identify 17% (n = 137) more deaths at 30 days, while overtriaging four times as many survivors.
CONCLUSIONS: Prehospital sBP is a modest discriminator of clinical outcomes, yet no threshold avoids substantial misclassification of 30-day mortality among noninjured patients.
Authors:
Christopher W Seymour; Colin R Cooke; Susan R Heckbert; Michael K Copass; Donald M Yealy; John A Spertus; Thomas D Rea
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Academic emergency medicine : official journal of the Society for Academic Emergency Medicine     Volume:  20     ISSN:  1553-2712     ISO Abbreviation:  Acad Emerg Med     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-06-13     Completed Date:  2013-10-21     Revised Date:  2014-01-24    
Medline Journal Info:
Nlm Unique ID:  9418450     Medline TA:  Acad Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  597-604     Citation Subset:  IM    
Copyright Information:
© 2013 by the Society for Academic Emergency Medicine.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Blood Pressure Determination / standards*
Cohort Studies
Differential Threshold
Early Diagnosis
Emergency Medical Services / standards*,  statistics & numerical data
Female
Hospital Mortality
Hospitals, Community / standards*,  statistics & numerical data
Humans
Hypotension / diagnosis*,  mortality
Male
Middle Aged
Predictive Value of Tests
ROC Curve
Survival Analysis
Survival Rate
Triage / standards*,  statistics & numerical data
Grant Support
ID/Acronym/Agency:
F32 HL103098/HL/NHLBI NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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