Narrow pulse pressure is independently associated with massive transfusion and emergent surgery in hemodynamically stable trauma patients

B Bankhead-Kendall; P Teixeira; S Roward; S Ali; A Ryder; S Sahi; T Cardenas; J Aydelotte; B Coopwood; C Brown

doi:10.1016/j.amjsurg.2020.06.042

Narrow pulse pressure is independently associated with massive transfusion and emergent surgery in hemodynamically stable trauma patients

Am J Surg. 2020 Nov;220(5):1319-1322. doi: 10.1016/j.amjsurg.2020.06.042. Epub 2020 Jul 20.

Authors

B Bankhead-Kendall¹, P Teixeira², S Roward³, S Ali⁴, A Ryder⁵, S Sahi⁶, T Cardenas⁷, J Aydelotte⁸, B Coopwood⁹, C Brown¹⁰

Affiliations

¹ Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, United States. Electronic address: [email protected].
² Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, United States. Electronic address: [email protected].
³ Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, United States. Electronic address: [email protected].
⁴ Trauma Services, Dell Seton Medical Center at the University of Texas at Austin, United States. Electronic address: [email protected].
⁵ Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, United States. Electronic address: [email protected].
⁶ Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, United States. Electronic address: [email protected].
⁷ Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, United States. Electronic address: [email protected].
⁸ Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, United States. Electronic address: [email protected].
⁹ Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, United States. Electronic address: [email protected].
¹⁰ Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, United States. Electronic address: [email protected].

PMID: 32826042
DOI: 10.1016/j.amjsurg.2020.06.042

Abstract

Introduction: Narrow pulse pressure (PP) is a sign of Class-II hemorrhage, but its clinical relevance is unknown. We hypothesized narrow PP is related to significant transfusion and need for emergent surgery.

Methods: Hemodynamically stable (SBP >/ = 90 mmHg) trauma patients were retrospectively reviewed. Narrow PP patients (<40 mmHg) were compared to normal patients (>/ = 40 mmHg). Outcomes included need for significant transfusion (>/ = 10 units) and emergent cavitary surgery.

Results: From 18,978 hemodynamically stable trauma patients admitted, 13% had narrow PP. They statistically required more massive transfusion, emergent surgery, or both (p < 0.0001), as well as higher mortality, longer hospital stay, and ICU stay (p < 0.0001). After controlling for age, gender, injury, ISS and GCS, NPP was independently associated with both significant transfusion and emergent surgery.

Conclusion: In hemodynamically stable trauma patients, narrow PP is independently associated with three-fold increase in significant transfusion need and two-fold increase in emergent surgery need. Early identification of these patients may lead to more accurate and optimal intervention.

Keywords: Blood transfusion; Pulse pressure; Trauma.

MeSH terms

Adult
Aged
Aged, 80 and over
Blood Pressure
Blood Pressure Determination
Blood Transfusion / statistics & numerical data*
Case-Control Studies
Clinical Decision Rules
Emergencies
Female
Hemorrhage / diagnosis*
Hemorrhage / etiology
Hemorrhage / therapy
Humans
Linear Models
Logistic Models
Male
Middle Aged
Prognosis
Retrospective Studies
Surgical Procedures, Operative / statistics & numerical data*
Wounds and Injuries / complications
Wounds and Injuries / diagnosis
Wounds and Injuries / physiopathology*
Wounds and Injuries / therapy*