title: Prehospital hypotension is a predictor of the need for an emergent, therapeutic operation in trauma patients with normal systolic blood pressure in the emergency department.
abstract: BACKGROUND
  To determine whether prehospital hypotension predicts the need for an emergent, therapeutic operation in trauma patients who present to the emergency department (ED) with normal systolic blood pressure (SBP).
  
  
  METHODS
  An observational, cohort study was conducted at a Level I, urban, county trauma center. Consecutive trauma patients not in cardiopulmonary arrest and transported to the ED by emergency medical services during a one-year period were studied. Data on prehospital and ED vital signs, subsequent hospital course, and surgical procedures were collected. The occurrence of an emergent, therapeutic operation, which was defined based on the types of injuries found or repaired within 6 hours of arrival, was determined from operative and hospital records.
  
  
  RESULTS
  Of the 1,227 total trauma patients, 160 were excluded because of cardiopulmonary arrest or inadequate documentation, leaving 1,067 study patients. Of those, 1,028 were normotensive on arrival to the ED. Seventy-one of the 1,028 patients (7%) were hypotensive in the field; 37% of these patients received an emergent, therapeutic operation and 6% died. Of the 1,028 patients, 957 (93%) were normotensive in the field; 11% of these patients received an emergent, therapeutic operation and 3% died. Thus, in trauma patients who were normotensive on arrival to the ED, the need for an emergent, therapeutic operation was more than three times more likely compared with those who had normal SBP in the field (odds ratio 4.5, 95% confidence interval 2.7-7.6). Mortality was also higher in the prehospital hypotension group (odds ratio 2.3, 95% confidence interval 0.8-6.9).
  
  
  CONCLUSIONS
  Prehospital hypotension is a strong predictor of the need for an emergent, therapeutic operation in trauma patients with normal SBP on arrival to the ED.
authors.affiliation: Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA 90509, USA. aril@emedharbor.edu
authors.forename: Ari M
authors.initials: AM
authors.lastname: Lipsky
authors.forename: Marianne
authors.initials: M
authors.lastname: Gausche-Hill
authors.forename: Philip L
authors.initials: PL
authors.lastname: Henneman
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Loffredo
authors.forename: Patricia B
authors.initials: PB
authors.lastname: Eckhardt
authors.forename: H Gill
authors.initials: HG
authors.lastname: Cryer
authors.forename: Christian
authors.initials: C
authors.lastname: de Virgilio
authors.forename: Stanley L
authors.initials: SL
authors.lastname: Klein
authors.forename: Frederic S
authors.initials: FS
authors.lastname: Bongard
authors.forename: Roger J
authors.initials: RJ
authors.lastname: Lewis
mesh_terms: D000293:Adolescent; D000328:Adult; D001794:Blood Pressure; D015331:Cohort Studies; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D006305:Health Status Indicators; D006801:Humans; D007022:Hypotension / Q000209:etiology*; D015588:Observer Variation; D012307:Risk Factors; D013997:Time Factors; D014947:Wounds and Injuries / Q000150:complications / Q000503:physiopathology* / Q000601:surgery