Prehospital hypertension is predictive of traumatic brain injury and is associated with higher mortality

Galinos Barmparas; Douglas Z Liou; Alexander W Lamb; Alexandra Gangi; Mike Chin; Eric J Ley; Ali Salim; Marko Bukur

doi:10.1097/TA.0000000000000382

Prehospital hypertension is predictive of traumatic brain injury and is associated with higher mortality

J Trauma Acute Care Surg. 2014 Oct;77(4):592-8. doi: 10.1097/TA.0000000000000382.

Authors

Galinos Barmparas¹, Douglas Z Liou, Alexander W Lamb, Alexandra Gangi, Mike Chin, Eric J Ley, Ali Salim, Marko Bukur

Affiliation

¹ From the Department of Surgery (G.B., D.Z.L., A.W.L., A.G., M.C., E.J.L.), Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, California; Department of Surgery (A.S.), Division of Acute Care Surgery and Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts; and Department of Surgery (M.B.), Division of Trauma Surgery and Surgical Critical Care, Delray Medical and Broward Health Medical Centers, Fort Lauderdale, Florida.

PMID: 25250599
DOI: 10.1097/TA.0000000000000382

Abstract

Background: The purpose of the current study was to investigate the effect of early adrenergic hyperactivity as manifested by prehospital (emergency medical service [EMS]) hypertension on outcomes of traumatic brain injury (TBI) patients and to develop a prognostic model of the presence of TBI based on EMS and admission (emergency department [ED]) hypertension.

Methods: This study is a retrospective review of the 2007 to 2008 National Trauma Data Bank including blunt trauma patients 15 years or older with available EMS and ED vital signs. Patients with head Abbreviated Injury Scale (AIS) score of 3 or greater were selected, and mortality was examined within EMS systolic blood pressure (SBP) groups: lower than 100 mm Hg, 110 mm Hg to 150 mm Hg, 160 mm Hg to 180 mm Hg, and 190 mm Hg to 230 mm Hg. A forward logistic regression model including the EMS heart rate, EMS SBP, EMS Glasgow Coma Scale (GCS) score, ED heart rate, and ED SBP was used to identify predictors of a TBI in patients with ED GCS score of less than or equal to 8, 9 to 13, and 14 to 15.

Results: For the 5-year study period, 315,242 patients met inclusion criteria. Adjusted odds for mortality increased in a stepwise fashion with increasing EMS SBP compared with patients with normal EMS SBP (adjusted odds ratio [95% confidence interval], 1.33 [1.22-1.44], p < 0.001, for EMS SBP of 160-180 mm Hg and 1.97 [1.76-2.21], p < 0.001, for EMS SBP of 190-230 mm Hg). A 7-point scoring system was developed for each ED GCS score group to predict the presence of a TBI. EMS SBP of greater than 150 mm Hg and ED SBP of greater than 150 mm Hg were both predictive of the presence of a TBI in patients with ED GCS score of 8 or less and in patients with ED GCS score of 9 to 13 or 14 to 15, respectively.

Conclusion: Prehospital hypertension in TBI is associated with a higher mortality risk. Early hypertension in the prehospital setting and at admission can be used to predict the presence of such injuries. These findings may have important early triage and treatment implications.

Level of evidence: Prognostic study, level III.

MeSH terms

Abbreviated Injury Scale
Brain Injuries / epidemiology*
Brain Injuries / mortality*
Female
Glasgow Coma Scale
Humans
Hypertension / epidemiology*
Male
Middle Aged
Outcome Assessment, Health Care
Prognosis