Significance of a hypotensive episode following traumatic injury: A retrospective observational study

Early hemodynamic assessment remains crucial for proper management in trauma settings. Hypotension is a vital indication in trauma patients to be considered upon initial triaging to assess the risk of bleeding and hypovolemic shock which entails significant clinical attention during initial resuscitation.

To assess whether an initial episode of prehospital or emergency department hypotension is associated with an increased risk of morbidity and mortality in trauma patients.

A retrospective analysis was performed to include all trauma patients hospitalized between 2011 and 2021. Hypotension was defined as a systolic blood pressure ≤ 90 mmHg in the prehospital setting or upon arrival to the hospital. Patients were classified into normotensive vs hypotensive and survivors vs non-survivors. Data was analyzed and compared, and multivariable logistic regression analysis was performed to identify the predictors of mortality.

Over the ten years, 17341 trauma admissions were analyzed, of which 1188 (6.9%) patients had hypotension episodes either at the scene or upon hospital arrival. Patients with hypotension were two years younger (P = 0.001) in age and were more likely to have higher pulse rate (P = 0.001), elevated shock index (P = 0.001), sustained more severe injuries, frequently required blood transfusion and laparotomy, and had higher complications and mortality rates. Multivariable regression analysis identified hypotension [adjusted odds ratio (aOR) = 2.505; 95% confidence interval (95%CI) = 1.798-3.489; P = 0.001] and acute respiratory distress syndrome (ARDS; aOR = 5.482; 95%CI = 3.297-9.116; P = 0.001) as independent predictors of mortality. Among hypotensive trauma patients, only ARDS (aOR = 3.518; 95%CI = 1.385-7.204; P = 0.006) was significantly associated with mortality.

Hypotensive episodes following trauma are associated with higher severity and mortality. The development of ARDS is an independent predictor of mortality in hypotensive trauma patients. A hypotensive episode is a warning sign and calls for aggressive, timely management following trauma.