Research Reports - The impact of arterial hypertension on polytrauma and traumatic brain injury

Dtsch Arztebl Int. 2012 Dec;109(49):849-56

Sellmann T, Miersch D, Kienbaum P, Flohé S, Schneppendahl J, Lefering R; Trauma Registry DGU

BACKGROUND: Pre-hospital hypotension in trauma patients is associated with high
mortality. Especially for patients with severe traumatic brain injury (TBI),
arterial normotension or even hypertension (AHT) is considered an important
mechanism for sustaining adequate cerebral perfusion pressure. The effect of
pre-hospital arterial hypertension (pAHT) on in-hospital mortality after trauma
has not been studied to date.
METHODS: We retrospectively analyzed data in the trauma registry of the German
Society for Trauma Surgery (DGU) on all trauma patients in Germany from 1993 to
2008 who were 16 to 80 years old at the time of the trauma and had an injury
severity score (ISS) of 9 or above (total, 42 500 patient data sets). For the
analysis, we divided the patients into two groups: those with and those without
TBI. We further divided the TBI patients into five subgroups depending on the
course of their systolic blood pressure up to the moment of their arrival at the
hospital. We also analyzed the patients' demographic data, patterns of injury,
and accident mechanisms.
RESULTS: Trauma patients with TBI and pAHT (142 of 561 patients) had a
significantly higher mortality than normotensive TBI patients (25.3% vs. 13.5%,
p<0.001). Arterial hypertension that either rises or falls before the patient
reaches the hospital is associated with higher in-hospital mortality. A
logistical regression analysis of 5384 patients revealed that patients with pAHT
(n = 561) had an odds ratio of 1.9 (95% confidence interval, 1.4 to 1.6) for
death in the hospital compared to normotensive patients (n = 6020).
CONCLUSION: Systolic blood pressure values above 160 mm Hg before arrival in the
hospital worsen the outcome of trauma patients with TBI.

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