Prehospital Hypotension Redefined

Background: The American College of Surgeons Committee on Trauma suggests prehospital systolic blood pressure (PSBP) < 90 mm Hg as a criterion for triage of injured patients to trauma centers. However, Advanced Trauma Life Support recognizes this threshold as a late sign of shock. We undertook the current. study to determine whether a higher PSBP threshold may identify patients at significant risk of death. Methods: A retrospective analysis of ,in urban, Level I trauma center registry data was undertaken in patients with complete information on PSBP (n = 16,365; 1994-2003). Several thresholds of PSBP were chosen: <= 60, <= 70, <= 80, <= 90, <= 100, and <= 110 mm Hg, and the relationship between each threshold of PSBP and patient outcomes was explored. A p value < 0.05 was considered statistically significant. Results: Mean age of patients was 36 +/- 16 years, and 81% sustained a blunt injury. PSBP strongly correlated with systolic blood pressure obtained in the emergency department (Pearson r 0.65, p < 0.001). The risk of death increased sharply when PSBP dropped < 110 mm Hg, with nearly 1 in 10 (8%) dying in file emergency department and one in six (15%) (lying eventually. Conclusions: The definition of prehospital hypotension used for triage of injured patients to trauma centers should he redefined as PSBP < 110 mm Mg. The impact of this redefinition on trauma center resource utilization should he studied further.