Understanding traumatic shock: out-of-hospital hypotension with and without other physiologic compromise

The Journal of Trauma and Acute Care Surgery
Craig D NewgardROC Investigators

Abstract

Among trauma patients with out-of-hospital hypotension, we evaluated the predictive value of systolic blood pressure (SBP) with and without other physiologic compromise for identifying trauma patients requiring early critical resources. This was a secondary analysis of a prospective cohort of injured patients 13 years or older with out-of-hospital hypotension (SBP ≤ 90 mm Hg) who were transported by 114 emergency medical service agencies to 56 Level I and II trauma centers in 11 regions of the United States and Canada from January 1, 2010, through June 30, 2011. The primary outcome was early critical resource use, defined as blood transfusion of 6 U or greater, major nonorthopedic surgery, interventional radiology, or death within 24 hours. Of 3,337 injured patients with out-of-hospital hypotension, 1,094 (33%) required early critical resources and 1,334 (40%) had serious injury (Injury Severity Score [ISS] ≥ 16). Patients with isolated hypotension required less early critical resources (14% vs. 52%), had less serious injury (20% vs. 61%), and had lower mortality (24 hours, 1% vs. 26%; in-hospital, 3% vs. 34%). The standardized probability of requiring early critical resources was lowest among patients with blunt injury and iso...Continue Reading

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Citations

Jan 19, 2015·Annals of Emergency Medicine·Craig D NewgardUNKNOWN ROC Investigators
Apr 14, 2016·The Journal of Trauma and Acute Care Surgery·Christopher C D EvansUNKNOWN Resuscitation Outcomes Consortium Investigators
Jan 27, 2018·Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors·Min Woo KimSo Yeon Kong

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