Faculty Collaboration Database

Presenting blood pressure in traumatic brain injury: a bimodal distribution of death. J Trauma 2011 Nov;71(5):1179-84

Date

04/20/2011

Pubmed ID

21502878

DOI

10.1097/TA.0b013e3182140d38

Scopus ID

2-s2.0-81455140931 (requires institutional sign-in at Scopus site)   51 Citations

Abstract

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.

Author List

Zafar SN, Millham FH, Chang Y, Fikry K, Alam HB, King DR, Velmahos GC, de Moya MA

Author

Marc Anthony De Moya MD Chief, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Abbreviated Injury Scale
Adolescent
Adult
Aged
Blood Pressure Determination
Brain Injuries
Chi-Square Distribution
Emergency Service, Hospital
Female
Humans
Insurance Coverage
Length of Stay
Logistic Models
Male
Middle Aged
Predictive Value of Tests
ROC Curve
Respiration, Artificial
Survival Analysis
Systole
United States
Vital Signs
Wounds, Nonpenetrating