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

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. (C) 2020 Elsevier Inc. All rights reserved.