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Traumatic Brain Injury l: Introduction01:28

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Systems Analysis of the Neuroinflammatory and Hemodynamic Response to Traumatic Brain Injury
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Redefining hypotension in traumatic brain injury.

Cherisse Berry1, Eric J Ley, Marko Bukur

  • 1Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States.

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Systemic hypotension, defined as systolic blood pressure below 110 mmHg, is linked to increased mortality in moderate to severe traumatic brain injury (TBI) patients. This study redefines hypotension thresholds for TBI, suggesting a higher SBP is needed for this patient group.

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Area of Science:

  • Trauma research
  • Neurological surgery
  • Critical care medicine

Background:

  • Systemic hypotension is a known predictor of mortality in traumatic brain injury (TBI).
  • Traditional hypotension definition (SBP<90 mmHg) may not be optimal for TBI patients.
  • Recent studies suggest higher SBP thresholds for hypotension in non-TBI trauma patients.

Purpose of the Study:

  • To investigate a higher systolic blood pressure (SBP) threshold for hypotension in isolated moderate to severe TBI.
  • To determine age-specific hypotension thresholds for TBI patients.
  • To identify the optimal SBP definition for predicting mortality in TBI.

Main Methods:

  • Retrospective review of 15,733 adult patients with isolated moderate to severe TBI.
  • Analysis of admission SBP (60-180 mmHg) across three age groups: 15-49, 50-69, and ≥70 years.
  • Statistical modeling to determine the best fit for hypotension definition and its association with mortality.

Main Results:

  • Optimal hypotension threshold identified as SBP<110 mmHg for patients aged 15-49 years (AOR 1.98).
  • Optimal hypotension threshold identified as SBP<100 mmHg for patients aged 50-69 years (AOR 2.20).
  • Optimal hypotension threshold identified as SBP<110 mmHg for patients aged ≥70 years (AOR 1.92).

Conclusions:

  • A revised hypotension definition of SBP<110 mmHg is proposed for moderate to severe TBI.
  • Age-specific thresholds suggest SBP<100 mmHg for 50-69 year olds and SBP<110 mmHg for other adult age groups.
  • Further research is recommended to validate this new hypotension definition using perfusion indices.