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Just One Drop: The Significance of a Single Hypotensive Blood Pressure Reading During Trauma Resuscitations

Seamon, Mark J. MD; Feather, Cristina MD; Smith, Brian P. MD; Kulp, Heather MPH; Gaughan, John P. PhD; Goldberg, Amy J. MD

The Journal of Trauma: Injury, Infection, and Critical Care: June 2010 - Volume 68 - Issue 6 - p 1289-1295
doi: 10.1097/TA.0b013e3181db05dc
Original Article

Background: Single, isolated hypotensive blood pressure (BP) measurements frequently are ignored or considered “erroneous.” Although their clinical significance remains unknown, we hypothesized that single, isolated hypotensive BP readings during trauma resuscitations signify the presence of severe injuries that often warrant immediate intervention.

Methods: A prospective observational study was performed on all trauma patients admitted from June 2008 to January 2009. Patients with a single systolic blood pressure (SBP) reading <110 mm Hg during their trauma resuscitation were evaluated, and demographics, hemodynamics, resuscitation (fluids, blood products, and duration), injuries, and operative or endovascular management were analyzed. Single and multiple variable logistic regression analyses were performed. Cutpoint analysis of the entire range of lowest single SBP measurements determined which SBP value best predicted the need for immediate therapeutic intervention.

Results: Patients (n = 145) were predominantly male (77.2%) but age (mean, 35.1 ± 15.3 years) and injury mechanisms varied (penetrating, 46.2%; blunt, 53.8%). Cutpoint analysis determined that a single SBP reading <105 mm Hg best predicted the need for immediate therapeutic intervention. Although 38.1% patients with isolated SBP <105 mm Hg measurements underwent immediate therapeutic operative or endovascular procedures, only 10.4% (p < 0.001) with isolated SBP ≥105 mm Hg required these procedures. Patients were 12.4 times (confidence interval: 2.6–59.2; p = 0.002) more likely to undergo immediate therapeutic intervention than those with a single SBP ≥105 mm Hg.

Conclusions: Single, isolated hypotensive BP measurements during trauma resuscitations should not be ignored or dismissed. Instead, our results suggest that a single SBP reading <105 mm Hg is associated with severe injuries that often require immediate operative or endovascular treatment and surgical intensive care unit admission.

From the Division of Trauma and Surgical Critical Care (M.J.S., H.K., A.J.G.), Department of Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania; Department of Surgery (C.F., B.P.S.), Temple University Hospital, Philadelphia, Pennsylvania; and Biostatistics Consulting Center (J.P.G.), Temple University School of Medicine, Philadelphia, Pennsylvania.

Submitted for publication September 18, 2009.

Accepted for publication February 25, 2010.

Presented at the 68th Annual Meeting of the American Association for the Surgery of Trauma, October 1–3, 2009, Pittsburgh, Pennsylvania.

Address for reprints: Mark J. Seamon, MD, Department of Surgery, Temple University School of Medicine, 3401 North Broad Street, Philadelphia, PA 19104; email: mark.seamon@tuhs.temple.edu.

© 2010 Lippincott Williams & Wilkins, Inc.