scholarly journals Hypotension of ⩽110 mmHg is Associated with Increased Mortality in South African Patients After Trauma

2017 ◽  
Vol 106 (3) ◽  
pp. 261-268 ◽  
Author(s):  
D.L. Clarke ◽  
P. Brysiewicz ◽  
B. Sartorius ◽  
J.L. Bruce ◽  
G.L. Laing
Keyword(s):  
Blood Pressure ◽  
Confidence Interval ◽  
Systolic Blood Pressure ◽  
Predictive Value ◽  
High Sensitivity ◽  
Base Deficit ◽  
Interquartile Range ◽  
Trauma Patients ◽  
High Positive Predictive Value ◽  
Very High

Introduction: This study used data from a prospectively maintained trauma database to assess the level of systolic blood pressure at which mortality rates for trauma begin to increase and to compare systolic blood pressure with base deficit as a predictor of outcome. Methodology: The Pietermaritzburg Metropolitan Trauma Service maintains a prospective digital trauma registry. All trauma patients admitted to the service for the period January 2012–January 2015 were included. Analysis was performed on systolic blood pressure relative to a number of selected markers of outcome and a variety of physiological parameters. Results: Out of an original data set of 2974 trauma patients, a total of 169 elective patients, 799 patients with isolated traumatic brain injury, and 27 patients with incomplete data were excluded to leave a sample size of 2148 patients. Of these, 1830 (85.2%) were males and 318 (14.8%) were females. The mean age (standard deviation) was 31.8 (12.0) years. The median age (interquartile range) was 29 (23–37) years. There were 89 deaths in this cohort (4.1%). The median systolic blood pressure (interquartile range) was 123 (112–136) mmHg. The median base deficit was −1.4 (interquartile range: −4.5 to 1). The inflection curves below with fitted non-linear curve clearly show the upward change in mortality frequency around a systolic blood pressure of ⩽110 mmHg as well for a base deficit below −5. A cutoff of <110 for systolic blood pressure yields a high sensitivity and very high positive predictive value of 82% (95% confidence interval: 81–84) and 98% (95% confidence interval: 97–98), but low specificity (56%) and negative predictive value (12%), respectively. Similar optimal cutoff analysis for base deficit versus mortality suggests base deficit >4.8 as a good predictor area under the curve (0.82; 95% confidence interval: 0.75–0.88). This cutoff yields a high sensitivity of 80% (95% confidence interval: 78–82), moderate specificity of 75% (95% confidence interval: 62–85), very high positive predictive value of 98% (95% confidence interval: 97–99) but low negative predictive value of 17% (15–28). Conclusion: The data suggest that traumatic shock starts to become manifest at a systolic blood pressure of 110 mmHg and that a systolic blood pressure reading of 90 mmHg represents an advanced state of shock. Systolic blood pressure by itself is a poor predictor of mortality and outcome. Base deficit appears to be a far better predictor of mortality than systolic blood pressure. Future models to categorize shock will have to combine vital signs with biochemical markers of hypoperfusion.

Mortality Risk Stratification in Elderly Trauma Patients Based on Initial Arterial Lactate and Base Deficit Levels

2011 ◽  
Vol 77 (10) ◽  
pp. 1337-1341 ◽  
Author(s):  
Angela L. Neville ◽  
Denis Nemtsev ◽  
Raed Manasrah ◽  
Scott D. Bricker ◽  
Brant A. Putnam
Keyword(s):  
Blood Pressure ◽  
Risk Stratification ◽  
Systolic Blood Pressure ◽  
Vital Signs ◽  
Base Deficit ◽  
Trauma Patients ◽  
Arterial Lactate ◽  
Urban Level ◽  
Level I ◽  
Elderly Trauma Patients

Elderly trauma patients have worse outcomes than their younger counterparts. Early risk stratification remains difficult, particularly because traditional vital signs are less reliable. We hypothesized that arrival lactate and base deficit (BD) could be used to predict mortality in elderly trauma patients with a normal admission blood pressure. We retrospectively evaluated the prospectively collected trauma registry at our urban Level I trauma center between 2003 and 2009. Patients sustaining blunt trauma, age 55 years or older, with a systolic blood pressure 90 mmHg or higher, and who had arterial lactate and/or BD measured within 4 hours of arrival comprised the study group. Primary outcomes were in-hospital and 24-hour mortality. There were 364 patients with a lactate and 324 with a BD drawn. Patients with a lactate 2.5 mmol or greater were 3.7 times more likely to die than those with a lactate less than 2.5 mmol (95% CI, 1.6 to 8.2; P = 0.0018). The OR for mortality was 5.2 (95% CI, 2.5 to 11.2; P < 0.0001) in patients with a BD -4 or less. Elevated lactate and BD were even stronger predictors of early mortality (within first 24 hours). After increasing the hypotension threshold to a systolic blood pressure 110 mmHg or greater, lactate and BD remained highly predictive of in-hospital and 24-hour mortality.

scholarly journals Low profile REBOA device for increasing systolic blood pressure in hemodynamic instability: single-center 4-year experience of use of ER-REBOA

2021 ◽  
Author(s):  
David T. McGreevy ◽  
Mitra Sadeghi ◽  
Kristofer F. Nilsson ◽  
Tal M. Hörer
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Hemodynamic Instability ◽  
Balloon Occlusion ◽  
University Hospital ◽  
Trauma Patients ◽  
Single Center ◽  
Hemorrhage Control ◽  
Single Center Experience ◽  
Low Profile

Abstract Background Hemodynamic instability due to torso hemorrhage can be managed with the assistance of resuscitative endovascular balloon occlusion of the aorta (REBOA). This is a report of a single-center experience using the ER-REBOA™ catheter for traumatic and non-traumatic cases as an adjunct to hemorrhage control and as part of the EndoVascular resuscitation and Trauma Management (EVTM) concept. The objective of this report is to describe the clinical usage, technical success, results, complications and outcomes of the ER-REBOA™ catheter at Örebro University hospital, a middle-sized university hospital in Europe. Methods Data concerning patients receiving the ER-REBOA™ catheter for any type of hemorrhagic shock and hemodynamic instability at Örebro University hospital in Sweden were collected prospectively from October 2015 to May 2020. Results A total of 24 patients received the ER-REBOA™ catheter (with the intention to use) for traumatic and non-traumatic hemodynamic control; it was used in 22 patients. REBOA was performed or supervised by vascular surgeons using 7–8 Fr sheaths with an anatomic landmark or ultrasound guidance. Systolic blood pressure (SBP) increased significantly from 50 mmHg (0–63) to 95 mmHg (70–121) post REBOA. In this cohort, distal embolization and balloon rupture due to atherosclerosis were reported in one patient and two patients developed renal failure. There were no cases of balloon migration. Overall 30-day survival was 59%, with 45% for trauma patients and 73% for non-traumatic patients. Responders to REBOA had a significantly lower rate of mortality at both 24 h and 30 days. Conclusions Our clinical data and experience show that the ER-REBOA™ catheter can be used for control of hemodynamic instability and to significantly increase SBP in both traumatic and non-traumatic cases, with relatively few complications. Responders to REBOA have a significantly lower rate of mortality.

Systolic blood pressure below 110mmHg is associated with increased mortality in penetrating major trauma patients: Multicentre cohort study

Resuscitation ◽  
2012 ◽  
Vol 83 (4) ◽  
pp. 476-481 ◽  
Author(s):  
Rebecca M. Hasler ◽  
Eveline Nüesch ◽  
Peter Jüni ◽  
Omar Bouamra ◽  
Aristomenis K. Exadaktylos ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cohort Study ◽  
Systolic Blood Pressure ◽  
Major Trauma ◽  
Trauma Patients ◽  
Multicentre Cohort Study ◽  
Multicentre Cohort

Abstract P052: Circulating Natural Killer Cells and Subclinical Cardiovascular Disease in the Multi-Ethnic Study of Atherosclerosis (MESA)

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Nancy S Jenny ◽  
Nels C Olson ◽  
Alicia M Ellis ◽  
Margaret F Doyle ◽  
Sally A Huber ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Confidence Interval ◽  
Systolic Blood Pressure ◽  
Nk Cells ◽  
Nk Cell ◽  
Agatston Score ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Race Ethnicity

Introduction: Clinically, natural killer (NK) cells are important in inflammatory and autoimmune diseases. As part of innate immunity, NK cells produce chemokines and inflammatory cytokines, potentially linking them to cardiovascular disease (CVD) development and progression as well. However, their role in human CVD is not clear. Hypothesis: NK cells are proatherogenic in humans and are associated with CVD risk factors and subclinical CVD measures. Methods: We examined cross-sectional associations of circulating NK cell levels with CVD risk factors, subclinical CVD measures and coronary artery calcium (CAC) in 891 White, Black, Chinese and Hispanic men and women (mean age 66 y) in the Multi-Ethnic Study of Atherosclerosis (MESA) at Exam 4 (2005-07). NK cell percent, percent of circulating lymphocytes that were CD3 - CD56 + CD16 + , was measured in whole blood by flow cytometry. CAC presence was defined as Agatston score > 0. Results: Mean (standard deviation) NK percent differed by race/ethnicity; 8.2% (4.7) in Whites, 11.3% (7.5) in Chinese (p<0.001 compared to Whites), 7.1 (4.2) in Blacks (p=0.007) and 8.4 (5.2) in Hispanics (p=0.6). NK cell percent was positively associated with age (p<0.001) and systolic blood pressure (P=0.003) in the full group. However, NK cell percent was lower in current smokers than in never smokers (p=0.002). Adjusting for age, sex, race/ethnicity, smoking, body mass index, systolic blood pressure, diabetes and dyslipidemia, NK cell percent was negatively associated with common carotid intima media thickness (IMT; β coefficient -0.01; 95% confidence interval -0.03, -0.003) but was not associated with internal carotid IMT (-0.002; -0.037, 0.033). Likewise, NK cell percent was not associated with the presence of CAC (compared those with no detectable CAC; relative risk 1.02; 95% confidence interval 0.96, 1.08) or continuous Agatston score in those with a positive score (β coefficient 0.16, 95% confidence interval -0.003, 0.32) in the full group (models adjusted as above). Results were similar across race/ethnic groups. Conclusions: Of clinical interest, CD3 - CD56 + CD16 + NK cell percent varied significantly by race/ethnicity in these men and women from MESA. However, NK cell percent was inconsistently associated with CVD risk factors; positively with age and systolic blood pressure, and negatively with smoking. NK cell percent was also negatively associated with common carotid IMT. Larger sample sizes and longitudinal analyses will be required to clarify the potential relationship between NK cells and atherosclerosis in humans.

scholarly journals Sex differences in risk factors for myocardial infarction: cohort study of UK Biobank participants

BMJ ◽  
2018 ◽  
pp. k4247 ◽  
Author(s):  
Elizabeth R C Millett ◽  
Sanne A E Peters ◽  
Mark Woodward
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Blood Pressure ◽  
Type 1 Diabetes ◽  
Sex Differences ◽  
Confidence Interval ◽  
Systolic Blood Pressure ◽  
Uk Biobank ◽  
Hazard Ratios

AbstractObjectivesTo investigate sex differences in risk factors for incident myocardial infarction (MI) and whether they vary with age.DesignProspective population based study.SettingUK Biobank.Participants471 998 participants (56% women; mean age 56.2) with no history of cardiovascular disease.Main outcome measureIncident (fatal and non-fatal) MI.Results5081 participants (1463 (28.8%) of whom were women) had MI over seven years’ mean follow-up, resulting in an incidence per 10 000 person years of 7.76 (95% confidence interval 7.37 to 8.16) for women and 24.35 (23.57 to 25.16) for men. Higher blood pressure indices, smoking intensity, body mass index, and the presence of diabetes were associated with an increased risk of MI in men and women, but associations were attenuated with age. In women, systolic blood pressure and hypertension, smoking status and intensity, and diabetes were associated with higher hazard ratios for MI compared with men: ratio of hazard ratios 1.09 (95% confidence interval 1.02 to 1.16) for systolic blood pressure, 1.55 (1.32 to 1.83) for current smoking, 2.91 (1.56 to 5.45) for type 1 diabetes, and 1.47 (1.16 to 1.87) for type 2 diabetes. There was no evidence that any of these ratios of hazard ratios decreased with age (P>0.2). With the exception of type 1 diabetes, the incidence of MI was higher in men than in women for all risk factors.ConclusionsAlthough the incidence of MI was higher in men than in women, several risk factors were more strongly associated with MI in women compared with men. Sex specific associations between risk factors and MI declined with age, but, where it occurred, the higher relative risk in women remained. As the population ages and the prevalence of lifestyle associated risk factors increase, the incidence of MI in women will likely become more similar to that in men.

scholarly journals Heterogeneous Exposure Associations in Observational Cohort Studies: The Example of Blood Pressure in Older Adults

2019 ◽  
Vol 189 (1) ◽  
pp. 55-67
Author(s):  
Michelle C Odden ◽  
Andreea M Rawlings ◽  
Abtin Khodadadi ◽  
Xiaoli Fern ◽  
Michael G Shlipak ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Confidence Interval ◽  
Systolic Blood Pressure ◽  
Cardiovascular Health ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Creatinine Concentration ◽  
Body Composition Study ◽  
Health Aging

Abstract Heterogeneous exposure associations (HEAs) can be defined as differences in the association of an exposure with an outcome among subgroups that differ by a set of characteristics. In this article, we intend to foster discussion of HEAs in the epidemiologic literature and present a variant of the random forest algorithm that can be used to identify HEAs. We demonstrate the use of this algorithm in the setting of the association between systolic blood pressure and death in older adults. The training set included pooled data from the baseline examination of the Cardiovascular Health Study (1989–1993), the Health, Aging, and Body Composition Study (1997–1998), and the Sacramento Area Latino Study on Aging (1998–1999). The test set included data from the National Health and Nutrition Examination Survey (1999–2002). The hazard ratios ranged from 1.25 (95% confidence interval: 1.13, 1.37) per 10-mm Hg increase in systolic blood pressure among men aged ≤67 years with diastolic blood pressure greater than 80 mm Hg to 1.00 (95% confidence interval: 0.96, 1.03) among women with creatinine concentration ≤0.7 mg/dL and a history of hypertension. HEAs have the potential to improve our understanding of disease mechanisms in diverse populations and guide the design of randomized controlled trials to control exposures in heterogeneous populations.

scholarly journals 23. Ambulance Sphygmomanometer Accuracy: Can It Affect Triage to the Trauma Center?

1996 ◽  
Vol 11 (S2) ◽  
pp. S33-S33
Author(s):  
Charles E. Cady ◽  
Ronald G. Pirrallo ◽  
Clarence E. Grim
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Blunt Trauma ◽  
Frequency Distribution ◽  
Trauma Center ◽  
Trauma Patients ◽  
Cross Sectional ◽  
Industry Standards ◽  
Study Population ◽  
The Mean

Objectives: To determine the accuracy of sphygmomanometers (SPHYGs) from a metropolitan EMS system and quantitate the mis-triage of adult blunt trauma patients based on erroneous systolic blood pressure (SBP) readings.Methods-A: A cross-sectional, convenient sample of 150 SPHYGs was checked for accuracy using industry standards. Mean high and low deviations were calculated at 90 mmHg.Methods-B: Retrospectively, a frequency distribution of the initial SBPs of all blunt trauma patients, age ≥21, seen in 1994 was plotted to characterize our study population. The numbers of patients potentially over- or under-triaged were identified when their reported SBP was corrected for using the mean high and low deviation plus 2 SDs.Results-A: Overall, 25.3% of the SPHYGs were inaccurate. At 90 mmHg, 28.0% (42/150) were inaccurate with 16.7% (7/42) high by 4.6±1.5 mmHg and 81.0% (34/42) low by 6.2±4.2 mmHg; one was inoperable.Results-B: 1,005 adult blunt trauma patients were evaluated; 61 were eliminated: 35 had initial SBPs of 0 mmHg and 26 had no SBP recorded (n = 944). The mean initial SBP was 138 ±30mmHg, and 3.8% (36/944) of the patients had SBPs <90 mmHg. Potentially, 2.0% (19/944) of the patients were undertriaged (initial erroneously high SBP reading 90–98 mmHg) and 2.5% (24/944) over-triaged (initial erroneously low SBP reading 74–90 mmHg).

scholarly journals Blunt Abdominal Trauma in a European Trauma Setting: Need for Complex or Non-Complex Skills in Emergency Laparotomy

2019 ◽  
Vol 109 (2) ◽  
pp. 89-95 ◽  
Author(s):  
J. Kosola ◽  
T. Brinck ◽  
A. Leppäniemi ◽  
L. Handolin
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Organ Injury ◽  
General Surgeon ◽  
Emergency Laparotomy ◽  
Trauma Patients ◽  
Emergency Procedures ◽  
Complex Skills

Background and Aims: Blunt abdominal trauma can lead to substantial organ injury and hemorrhage necessitating open abdominal surgery. Currently, the trend in surgeon training is shifting away from general surgery and the surgical treatment of blunt abdominal trauma patients is often done by sub-specialized surgeons. The aim of this study was to identify what emergency procedures are needed after blunt abdominal trauma and whether they can be performed with the skill set of a general surgeon. Materials and Methods: The records of blunt abdominal trauma patients requiring emergency laparotomy (n = 100) over the period 2006–2016 (Helsinki University Hospital Trauma Registry) were reviewed. The organ injuries and the complexity of the procedures were evaluated. Results: A total of 89 patients (no need for complex skills, NCS) were treated with the skill set of general surgeons while 11 patients required complex skills. Complex skills patients were more severely injured (New Injury Severity Score 56.4 vs 35.9, p < 0.001) and had a lower systolic blood pressure (mean: 89 vs 112, p = 0.044) and higher mean shock index (heart rate/systolic blood pressure: 1.43 vs 0.95, p = 0.012) on admission compared with NCS patients. The top three NCS procedures were splenectomy (n = 33), bowel repair (n = 31), and urinary bladder repair (n = 16). In patients requiring a complex procedure (CS), the bleeding site was the liver (n = 7) or a major blood vessel (n = 4). Conclusion: The majority of patients requiring emergency laparotomy can be managed with the skills of a general surgeon. Non-responder blunt abdominal trauma patients with positive ultrasound are highly likely to require complex skills. The future training of surgeons should concentrate on NCS procedures while at the same time recognizing those injuries requiring complex skills.

scholarly journals Equivalency between the shock index and subtracting the systolic blood pressure from the heart rate: an observational cohort study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yohei Kamikawa ◽  
Hiroyuki Hayashi
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cohort Study ◽  
Confidence Interval ◽  
Systolic Blood Pressure ◽  
Correlation Coefficient ◽  
Observational Cohort Study ◽  
Regression Equation ◽  
Shock Index ◽  
Observational Cohort

Abstract Background Although the shock index is known to predict mortality and other severe outcomes, deriving it requires complex calculations. Subtracting the systolic blood pressure from the heart rate may produce a simple shock index that would be a clinically useful substitute for the shock index. In this study, we investigated whether the simple shock index was equivalent to the shock index. Methods This observational cohort study was conducted at 2 tertiary care hospitals. Patients who were transported by ambulance were recruited for this study and were excluded if they were aged < 15 years, had experienced prehospital cardiopulmonary arrest, or had undergone inter-hospital transfer. Pearson’s product-moment correlation coefficient and regression equation were calculated, and two one-sided tests were performed to examine their equivalency. Results Among 5429 eligible patients, the correlation coefficient between the shock index and simple shock index was extremely high (0.917, 95% confidence interval 0.912 to 0.921, P < .001). The regression equation was estimated as sSI = 258.55 log SI. The two one-sided tests revealed a very strong equivalency between the shock index and the index estimated by the above equation using the simple shock index (mean difference was 0.004, 90% confidence interval 0.003 to 0.005). Conclusion The simple shock index strongly correlated with the shock index.

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