Systemic hypotension is a late marker of shock after trauma: a validation study of Advanced Trauma Life Support principles in a large national sample.
BACKGROUND
Systolic blood pressure is used extensively to triage trauma patients as stable or unstable, contrary to Advanced Trauma Life Support recommendations. We hypothesized that systemic hypotension is a late marker of shock.


METHODS
The National Trauma Data Bank was queried (n = 115,830). Base deficit was used as a measure of circulatory shock. Systolic blood pressure was correlated with the presence and the severity of base-deficit derangement.


RESULTS
Systolic blood pressure correlated poorly with base deficit (r = .28). There was wide variation in systolic blood pressure within each base-deficit group. The mean and median systolic blood pressure did not decrease to less than 90 mm Hg until the base deficit was worse than -20, with mortality reaching 65%.


CONCLUSIONS
We validated the Advanced Trauma Life Support principle that systemic hypotension is a late marker of shock. A normal blood pressure should not deter aggressive evaluation and resuscitation of trauma patients.
Parks
Jennifer K
JK
Department of Surgery, Division of Burns, Trauma, Surgical Critical Care, 5323 Harry Hines Blvd., Dallas, TX 75390-9158, USA.
Elliott
Alan C
AC
Gentilello
Larry M
LM
Shafi
Shahid
S
D000328:Adult; D019992:Databases as Topic; D005260:Female; D006801:Humans; D007022:Hypotension / Q000209:etiology* / Q000628:therapy; D008297:Male; D012151:Resuscitation / Q000379:methods*; D012771:Shock, Hemorrhagic / Q000209:etiology / Q000628:therapy*; D013997:Time Factors; D014218:Triage; D014947:Wounds and Injuries / Q000150:complications / Q000628:therapy*