The Impact of Age and Receipt Antihypertensives to Systolic Blood Pressure and Shock Index at Injury Scene and in the Emergency Department to Predict Massive Transfusion in Trauma Patients

Abstract Background : Systolic blood pressure (SBP) and shock index (SI) are accurate indicators of hemodynamic instability and the need for transfusion in trauma patients. We aimed to determine whether the utility and cutoff point for SBP and SI are affected by age or antihypertensives. Methods : This was a retrospective observational study of a level 1 trauma center between January 2017 and December 2018. We analyzed the utility and cutoff points of SBP and SI for predicting massive transfusion (MT) and 30-day mortality according to patients’ age and whether they were taking antihypertensives. Results : We analyzed 4681 trauma cases. There were 1949 patients aged 65 years or older (41.6%), and 1375 (29.4%) hypertensive patients. MT was given to 137 patients (2.9%). The 30-day mortality rate was 6.3% (n = 294). In geriatric trauma patients taking antihypertensives, prehospital SBP less than 110 mmHg was the cutoff value for predicting MT in multivariate logistic regression analyses; packed red blood cell transfusion volume decreased abruptly based on prehospital SBP of 110 mmHg. Emergency Department SI greater than 1.0 was the cutoff value for the prediction of MT in patients who were older than 65 years who were not taking antihypertensives. Conclusions : The triage of trauma patients is based on the identification of clinical features that are readily identifiable by first responders. However, age and medications may also affect accurate evaluation. In initial trauma management, we must apply SBP and SI differently depending on age, whether a patient is taking antihypertensives, and the time at which the indicators are measured.

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The Impact of Age and Receipt Antihypertensives to Systolic Blood Pressure and Shock Index at Injury Scene and in the Emergency Department to Predict Massive Transfusion in Trauma Patients

10.21203/rs.3.rs-33779/v2 ◽

2020 ◽

Author(s):

Se Jin Park ◽

Mi Jin Lee ◽

Changho Kim ◽

Haewon Jung ◽

Seong Hun Kim ◽

...

Keyword(s):

Blood Pressure ◽

Emergency Department ◽

Logistic Regression ◽

Systolic Blood Pressure ◽

Massive Transfusion ◽

Red Blood Cell Transfusion ◽

Trauma Patients ◽

Shock Index ◽

Cutoff Value ◽

The Impact

Abstract Background: Systolic blood pressure (SBP) and shock index (SI) are accurate indicators of hemodynamic instability and the need for transfusion in trauma patients. We aimed to determine whether the utility and cutoff point for SBP and SI are affected by age and antihypertensives. Methods: This was a retrospective observational study of a level 1 trauma center between January 2017 and December 2018. We analyzed the utility and cutoff points of SBP and SI for predicting massive transfusion (MT) and 30-day mortality according to patients’ age and whether they were taking antihypertensives. A multivariable logistic regression analysis was conducted to estimate the association of age and antihypertensives on primary and secondary outcomes. Results: We analyzed 4681 trauma cases. There were 1949 patients aged 65 years or older (41.6%), and 1375 hypertensive patients (29.4%). MT was given to 137 patients (2.9%). The 30-day mortality rate was 6.3% (n = 294). In geriatric trauma patients taking antihypertensives, a prehospital SBP less than 110 mmHg was the cutoff value for predicting MT in multivariate logistic regression analyses; packed red blood cell transfusion volume decreased abruptly based on prehospital SBP of 110 mmHg. Emergency Department SI greater than 1.0 was the cutoff value for predicting MT in patients who were older than 65 years and were not taking antihypertensives. Conclusions: The triage of trauma patients is based on the identification of clinical features readily identifiable by first responders. However, age and medications may also affect the accurate evaluation. In initial trauma management, we must apply SBP and SI differently depending on age, whether a patient is taking antihypertensives, and the time at which the indicators are measured.

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The impact of age and receipt antihypertensives to systolic blood pressure and shock index at injury scene and in the emergency department to predict massive transfusion in trauma patients

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-021-00840-2 ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Se Jin Park ◽

Mi Jin Lee ◽

Changho Kim ◽

Haewon Jung ◽

Seong Hun Kim ◽

...

Keyword(s):

Blood Pressure ◽

Emergency Department ◽

Logistic Regression ◽

Systolic Blood Pressure ◽

Massive Transfusion ◽

Red Blood Cell Transfusion ◽

Trauma Patients ◽

Shock Index ◽

Cutoff Value ◽

The Impact

Abstract Background Systolic blood pressure (SBP) and shock index (SI) are accurate indicators of hemodynamic instability and the need for transfusion in trauma patients. We aimed to determine whether the utility and cutoff point for SBP and SI are affected by age and antihypertensives. Methods This was a retrospective observational study of a level 1 trauma center between January 2017 and December 2018. We analyzed the utility and cutoff points of SBP and SI for predicting massive transfusion (MT) and 30-day mortality according to patients’ age and whether they were taking antihypertensives. A multivariable logistic regression analysis was conducted to estimate the association of age and antihypertensives on primary and secondary outcomes. Results We analyzed 4681 trauma cases. There were 1949 patients aged 65 years or older (41.6%), and 1375 hypertensive patients (29.4%). MT was given to 137 patients (2.9%). The 30-day mortality rate was 6.3% (n = 294). In geriatric trauma patients taking antihypertensives, a prehospital SBP less than 110 mmHg was the cutoff value for predicting MT in multivariate logistic regression analyses; packed red blood cell transfusion volume decreased abruptly based on prehospital SBP of 110 mmHg. Emergency Department SI greater than 1.0 was the cutoff value for predicting MT in patients who were older than 65 years and were not taking antihypertensives. Conclusions The triage of trauma patients is based on the identification of clinical features readily identifiable by first responders. However, age and medications may also affect the accurate evaluation. In initial trauma management, we must apply SBP and SI differently depending on age, whether a patient is taking antihypertensives, and the time at which the indicators are measured.

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Prehospital Hypotension is a Predictor of the Need For an Emergent, Therapeutic Operation in Trauma Patients With Normal Systolic Blood Pressure in the Emergency Department

Journal of Trauma and Acute Care Surgery ◽

10.1097/01.ta.0000196694.52615.84 ◽

2006 ◽

Vol 61 (5) ◽

pp. 1228-1233 ◽

Cited By ~ 44

Author(s):

Ari M. Lipsky ◽

Marianne Gausche-Hill ◽

Philip L. Henneman ◽

Anthony J. Loffredo ◽

Patricia B. Eckhardt ◽

...

Keyword(s):

Blood Pressure ◽

Emergency Department ◽

Systolic Blood Pressure ◽

Trauma Patients

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Should Trauma Patients with a Glasgow Coma Scale Score of 3 Be Intubated Prior to Hospital Arrival?

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00008736 ◽

2010 ◽

Vol 25 (6) ◽

pp. 541-546 ◽

Cited By ~ 11

Author(s):

Charlene B. Irvin ◽

Susan Szpunar ◽

Lauren A. Cindrich ◽

Justin Walters ◽

Robert Sills

Keyword(s):

Blood Pressure ◽

Emergency Department ◽

Logistic Regression ◽

Glasgow Coma Scale ◽

Systolic Blood Pressure ◽

Endotracheal Intubation ◽

Body Region ◽

Trauma Patients ◽

Hospital Arrival ◽

Prehospital Endotracheal Intubation

AbstractIntroduction:Previous studies of heterogeneous populations (Glasgow Coma Scale (GCS) scores <9) suggest that endotracheal intubaton of trauma patients prior to hospital arrival (i.e., prehospital intubated) is associated with an increased mortality compared to those patients not intubated in the pre-hospital setting. Deeply comatose patients (GCS = 3) represent a unique population of severely traumatized patients and may benefit from intubation in the prehospital setting. The objective of this study was to compare mortality rates of severely comatose patients (scene GCS = 3) with prehospital endotracheal intubation to those intubated at the hospital.Methods:Using the National Trauma Data Bank (V. 6.2), the following variables were analyzed retrospectively: (1) age; (2) injury type (blunt or penetrating); (3) Injury Severity Score (ISS); (4) scene GCS = 3 (scored prior to intubation/without sedation); (5) emergency department GCS score; (6) arrival emergency department intubation status; (7) first systolic blood pressure in the emergency department (>0); (8) discharge status (alive or dead); (9) Abbreviated Injury Scale Score (AIS); and (10) AIS body region.Results:Of the 10,948 patients analyzed, 23% (2,491/10,948) were endotracheally intubated in a prehospital setting. Mortality rate for those hospital intubated was 35% vs. 62% for those with prehospital intubation (p <0.0001); mean ISS scores 24.2 ±16.0 vs. 31.6 ±16.2, respectively (p <0.0001). Using logistic regression, controlling for first systolic blood pressure, ISS, emergency department GCS, age, and type of trauma, those with prehospital intubation were more likely to die (OR = 1.9, 95% CI = 1.7−2.2). For patients with only head AIS scores (no other body region injury, n = 1,504), logistic regression (controlling for all other variables) indicated that those with prehospital intubation were still more likely to die (OR = 2.0. 95% CI = 1.4−2.9).Conclusions:Prehospital endotracheal intubation is associated with an increased mortality in completely comatose trauma patients (GCS = 3). Although the exact reasons for this remain unclear, these results support other studies and suggest the need for future research and re-appraisal of current policies for prehospital intubation in these severely traumatized patients.

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Prehospital Hypotension is a Predictor of the Need for an Emergent, Therapeutic Operation in Trauma Patients With Normal Systolic Blood Pressure in the Emergency Department

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2006.12.039 ◽

2007 ◽

Vol 32 (3) ◽

pp. 324

Author(s):

Shaun C. Spalding

Keyword(s):

Blood Pressure ◽

Emergency Department ◽

Systolic Blood Pressure ◽

Trauma Patients

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Vital Signs Strongly Predict Massive Transfusion Need in Geriatric Trauma Patients

The American Surgeon ◽

10.1177/000313481608200730 ◽

2016 ◽

Vol 82 (7) ◽

pp. 632-636 ◽

Cited By ~ 4

Author(s):

Scott C. Fligor ◽

Mark E. Hamill ◽

Katie M. Love ◽

Bryan R. Collier ◽

Dan Lollar ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Massive Transfusion ◽

Early Recognition ◽

Characteristic Curve ◽

Vital Signs ◽

Trauma Team ◽

Geriatric Trauma ◽

Trauma Patients ◽

Geriatric Population

Early recognition of massive transfusion (MT) requirement in geriatric trauma patients presents a challenge, as older patients present with vital signs outside of traditional thresholds for hypotension and tachycardia. Although many systems exist to predict MT need in trauma patients, none have specifically evaluated the geriatric population. We sought to evaluate the predictive value of presenting vital signs in geriatric trauma patients for prediction of MT. We retrospectively reviewed geriatric trauma patients presenting to our Level I trauma center from 2010 to 2013 requiring full trauma team activation. The area under the receiver operating characteristic curve was calculated to assess discrimination of arrival vital signs for MT prediction. Ideal cutoffs with high sensitivity and specificity were identified. A total of 194 patients with complete data were analyzed. Of these, 16 patients received MT. There was no difference between the MT and non-MT groups in sex, age, or mechanism. Systolic blood pressure, pulse pressure, diastolic blood pressure, and shock index all were strongly predictive of MT need. Interestingly, we found that heart rate does not predict MT. MT in geriatric trauma patients can be reliably and simply predicted by arrival vital signs. Heart rate may not reflect serious hemorrhage in this population.

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Temporal changes in blood pressure following prehospital rapid sequence intubation

Emergency Medicine Journal ◽

10.1136/emermed-2020-210887 ◽

2021 ◽

pp. emermed-2020-210887

Author(s):

Pieter Francsois Fouche ◽

Ben Meadley ◽

Toby StClair ◽

Alison Winnall ◽

Christopher Stein ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Median Number ◽

Rapid Sequence Intubation ◽

Trauma Patients ◽

Shock Index ◽

Fractional Polynomial ◽

Rapid Sequence ◽

Transient Elevation ◽

Pressure Changes

BackgroundRapid Sequence intubation (RSI) is an airway procedure that uses sedative and paralytic drugs to facilitate endotracheal intubation. It is known that RSI could impact blood pressure in the peri-intubation period. However, little is known about blood pressure changes in longer time frames. Therefore, this analysis aims to describe the changes in systolic blood pressure in a large cohort of paramedic-led RSI cases over the whole prehospital timespan.MethodsIntensive Care Paramedics in Victoria, Australia, are authorised to use RSI in medical or trauma patients with a Glasgow Coma Scale <10. This retrospective cohort study analysed data from patientcare records for patients aged 12 years and above that had received RSI, from 1 January 2008 to 31 December 2019. This study quantifies the systolic blood pressure changes using regression with fractional polynomial terms. The analysis is further stratified by high versus Low Shock Index (LSI). The shock index is calculated by dividing pulse rate by systolic blood pressure.ResultsDuring the study period RSI was used in 8613 patients. The median number of blood pressure measurements was 5 (IQR 3–8). Systolic blood pressure rose significantly by 3.4 mm Hg (p<0.001) and then returned to baseline in the first 5 min after intubation for LSI cases. No initial rise in blood pressure is apparent in High Shock Index (HSI) cases. Across the whole cohort, systolic blood pressure decreased by 7.1 mm Hg (95% CI 7.9 to 6.3 mm Hg; p<0.001) from the first to the last blood pressure measured.ConclusionsOur study shows that in RSI patients a small transient elevation in systolic blood pressure in the immediate postintubation period is found in LSI, but this elevation is not apparent in HSI. Blood pressure decreased over the prehospital phase in RSI patients with LSI, but increased for HSI cases.

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