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.
Partrick
David A
DA
Department of Pediatric Surgery, The Children's Hospital, University of Colorado, 1950 Ogden St., B-323, Denver 80218, USA. Patrick.David@tchden.org
Bensard
Denis D
DD
Janik
Joseph S
JS
Karrer
Frederick M
FM
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D016489:Head Injuries, Closed / Q000209:etiology*; D006801:Humans; D007022:Hypotension / Q000209:etiology*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D012771:Shock, Hemorrhagic / Q000209:etiology*; D015599:Trauma Severity Indices; D014949:Wounds, Nonpenetrating / Q000150:complications*