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Association of Out-of-Hospital Hypotension Depth and Duration With Traumatic Brain Injury Mortality
Daniel W Spaite1, Chengcheng Hu2, Bentley J Bobrow3
1Arizona Emergency Medicine Research Center, College of Medicine, University of Arizona, Phoenix, AZ; Department of Emergency Medicine, College of Medicine, University of Arizona, Tucson, AZ.
Annals of Emergency Medicine
|June 1, 2017
Summary
Out-of-hospital hypotension in traumatic brain injury (TBI) significantly increases mortality. Both the depth and duration of low blood pressure contribute to higher death rates in TBI patients.
Area of Science:
- Emergency Medicine
- Neurosurgery
- Trauma Surgery
Background:
- Out-of-hospital hypotension is a known risk factor for mortality in patients with traumatic brain injury (TBI).
- The specific relationship between the depth and duration of hypotension and TBI mortality remains incompletely understood.
Purpose of the Study:
- To investigate the association between the depth-duration dose of out-of-hospital hypotension and in-hospital mortality in patients with major traumatic brain injury.
- To quantify the impact of varying levels of hypotension on TBI outcomes.
Main Methods:
- Analysis of a preimplementation cohort from Arizona's Excellence in Prehospital Injury Care study, including adults and older children with moderate to severe TBI.
- Logistic regression was used to model the association between the integrated depth and duration of hypotension (systolic blood pressure <90 mm Hg) and in-hospital death, controlling for confounders.
Main Results:
- The study included 7,521 TBI cases; 539 experienced out-of-hospital hypotension.
- Mortality was significantly higher in hypotensive patients (33.4%) compared to non-hypotensive patients (7.8%).
- Mortality increased progressively with higher hypotension doses, ranging from 16.3% to 50.4% for increasing quartiles of the depth-duration dose.
Conclusions:
- Both the depth and duration of out-of-hospital hypotension are significantly associated with increased mortality in traumatic brain injury.
- Clinical assessments of TBI patients should incorporate both the depth and duration of prehospital hypotension when evaluating outcomes.
