Prehospital hypotension that persists on arrival at the emergency department is a powerful predictor of mortality following major trauma

Objective

Outcome following major injury is time dependent. Early identification of high-risk patients allows rapid decision-making and correction of life-threatening disorders. Complex scoring systems are of limited value during major trauma resuscitation. Our aim was to evaluate the utility of a single blood pressure during the prehospital phase in combination with the blood pressure on arrival at the emergency department.

Methods

Data were collected prospectively on 1,111 patients admitted to a Level 1 South African trauma unit over a 1-year period. Patients were subdivided into two groups according to the combination of their prehospital (PH) and emergency department (ED) blood pressure. Hypotension was defined as a systolic blood pressure less than 90 mmHg. Mortality was defined as death within 30 days.

Results

The mortality in patients (n = 1,031) with normal PH and ED blood pressure was 5.4%. The mortality in patients (n = 80) with PH and ED hypotension was significantly higher at 45% (P < 0.0001, chi-square test) (Table 1).

Table 1 abstract P346

Conclusion

The combination of prehospital and emergency department systolic blood pressure is a simple yet extremely powerful predictor of mortality following major trauma and should be used as a triage tool to rapidly identify the highest risk patients.