Is hypotension a reliable indicator of blood loss from traumatic injury in children?

Background: Traditional surgical teaching stresses that hypotension is an indicator of loss of circulating blood volume. The purpose of this study is to critically evaluate hypotensive injured children for evidence of a hemorrhagic insult. Methods: Over a 2-year period, data were collected prospectively from children injured via a blunt mechanism. Systolic blood pressure (SBP) was recorded in the field and on arrival to the emergency department. Results: In all, 194 injured children were identified as hypotensive. Only 82 (42%) had identifiable injuries to account for significant volume loss. Children 0 to 5 years old had a 61% incidence of isolated head injury (46 of 76) and only a 34% incidence of hemorrhagic insult (26 of 76). Children 6 to 12 years old had a 31% incidence of isolated head injury (22 of 72) and a 52% incidence of hemorrhagic insult (38 of 72). Finally, patients more than 12 years old had a 33% incidence of isolated head injury (15 of 46) and a 39% incidence of hemorrhagic insult (18 of 46). Conclusions: Hypotension should not be viewed only as a potential marker of loss of circulating volume, but also as a possible indicator of head injury in young trauma victims. (C) 2002 Excerpta Medica Inc. All rights reserved.