title: Systemic hypotension is a late marker of shock after trauma: a validation study of Advanced Trauma Life Support principles in a large national sample.
abstract: 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.
authors.affiliation: Department of Surgery, Division of Burns, Trauma, Surgical Critical Care, 5323 Harry Hines Blvd., Dallas, TX 75390-9158, USA.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Parks
authors.forename: Alan C
authors.initials: AC
authors.lastname: Elliott
authors.forename: Larry M
authors.initials: LM
authors.lastname: Gentilello
authors.forename: Shahid
authors.initials: S
authors.lastname: Shafi
mesh_terms: 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*