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Presenting Blood Pressure in Traumatic Brain Injury: A Bimodal Distribution of Death.
MedLine Citation:
PMID:  21502878     Owner:  NLM     Status:  Publisher    
BACKGROUND:: Recent research explores the relationship between vital signs on arrival to the emergency department and early outcomes. This work has not included traumatic brain injury (TBI). We aimed to evaluate the relationship of the initial emergency department systolic blood pressure (EDSBP) with outcome. METHODS:: By using the National Trauma Data Bank (v7), we analyzed patients older than 16 years with isolated moderate to severe blunt TBI. TBI was defined by International Classification of Diseases-9th Rev diagnosis codes and Abbreviated Injury Scale scores. We determined mortality rates while controlling for age, gender, race, payment type, and injury severity using logistic regression. Survival analysis was performed to determine 3-day survival rates. Scores and rates were plotted against EDSBP. RESULTS:: A total of 7,238 patients were included in the analysis. Plots of adverse outcomes versus EDSBP demonstrated bimodal distributions. The mortality curve had one inflection point at EDSBP 120 mm Hg, indicating higher mortality when blood pressures were lower than this threshold. Another inflection began at EDSBP 140 mm Hg. The mortality rate was 21% when EDSBP was <120 mm Hg, 9% when it was between 120 mm Hg and 140 mm Hg, and 19% when EDSBP was ≥140 mm Hg. Multivariate analysis demonstrated that patients presenting with an EDSBP of <120 mm Hg and ≥140 mm Hg were 2.7 (95% confidence interval =2.13,3.48) and 1.6 (95% confidence interval =1.32,1.96) times more likely to die, respectively, than those who presented with a EDSBP of 120 mm Hg to 140 mm Hg. CONCLUSIONS:: Mortality in moderate to severe TBI has a bimodal distribution. Like hypotension, hypertension at hospital admission seems to be associated with increased mortality in TBI, even after controlling for other factors.
Syed Nabeel Zafar; Frederick H Millham; Yuchiao Chang; Karim Fikry; Hasan B Alam; David R King; George C Velmahos; Marc A de Moya
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-4-15
Journal Detail:
Title:  The Journal of trauma     Volume:  -     ISSN:  1529-8809     ISO Abbreviation:  -     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-4-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
From the Harvard School of Public health (S.N.Z.), Boston Massachusetts; Department of Surgery (F.H.M.), Newton-Wellesley Hospital, Newton, Massachusetts; General Medicine Division (Y.C.), Massachusetts General Hospital; and Division of Trauma, Emergency Surgery and Surgical Critical Care (K.F., H.B.A., D.R.K., G.C.V., M.A.D.), Massachusetts General Hospital, Boston, Massachusetts.
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