Research Reports - Prehospital hypertension in traumatic brain injury is associated with a higher mortality risk.
J Trauma Acute Care Surg. 2014 Oct;77(4):592-8
Barmparas G(1), Liou DZ, Lamb AW, Gangi A, Chin M, Ley EJ, Salim A, Bukur M
BACKGROUND: The purpose of the current study was to investigate the effect of
early adrenergic hyperactivity as manifested by prehospital (emergency medical
service [EMS]) hypertension on outcomes of traumatic brain injury (TBI) patients
and to develop a prognostic model of the presence of TBI based on EMS and
admission (emergency department [ED]) hypertension.
METHODS: This study is a retrospective review of the 2007 to 2008 National Trauma
Data Bank including blunt trauma patients 15 years or older with available EMS
and ED vital signs. Patients with head Abbreviated Injury Scale (AIS) score of 3
or greater were selected, and mortality was examined within EMS systolic blood
pressure (SBP) groups: lower than 100 mm Hg, 110 mm Hg to 150 mm Hg, 160 mm Hg to
180 mm Hg, and 190 mm Hg to 230 mm Hg. A forward logistic regression model
including the EMS heart rate, EMS SBP, EMS Glasgow Coma Scale (GCS) score, ED
heart rate, and ED SBP was used to identify predictors of a TBI in patients with
ED GCS score of less than or equal to 8, 9 to 13, and 14 to 15.
RESULTS: For the 5-year study period, 315,242 patients met inclusion criteria.
Adjusted odds for mortality increased in a stepwise fashion with increasing EMS
SBP compared with patients with normal EMS SBP (adjusted odds ratio [95%
confidence interval], 1.33 [1.22-1.44], p < 0.001, for EMS SBP of 160-180 mm Hg
and 1.97 [1.76-2.21], p < 0.001, for EMS SBP of 190-230 mm Hg). A 7-point scoring
system was developed for each ED GCS score group to predict the presence of a
TBI. EMS SBP of greater than 150 mm Hg and ED SBP of greater than 150 mm Hg were
both predictive of the presence of a TBI in patients with ED GCS score of 8 or
less and in patients with ED GCS score of 9 to 13 or 14 to 15, respectively.
CONCLUSION: Prehospital hypertension in TBI is associated with a higher mortality
risk. Early hypertension in the prehospital setting and at admission can be used
to predict the presence of such injuries. These findings may have important early
triage and treatment implications.
LEVEL OF EVIDENCE: Prognostic study, level III.