title: Systolic blood pressure below 110 mmHg is associated with increased mortality in penetrating major trauma patients: Multicentre cohort study.
abstract: BACKGROUND
  Non-invasive systolic blood pressure (SBP) measurement is a commonly used triaging tool for trauma patients. A SBP of <90mmHg has represented the threshold for hypotension for many years, but recent studies have suggested redefining hypotension at lower levels. We therefore examined the association between SBP and mortality in penetrating trauma patients.
  
  
  METHODS
  We conducted a prospective cohort study in adult (≥16 years) penetrating trauma patients. Patients were admitted to hospitals belonging to the Trauma Audit and Research Network (TARN) between 2000 and 2009. The main outcome measure was the association between SBP and mortality at 30 days. Multivariate logistic regression models adjusted for the influence of age, gender, Injury Severity Score (ISS) and Glasgow Coma Score (GCS) on mortality were used.
  
  
  RESULTS
  3444 patients with a median age of 30 years (IQR 22.5-41.4), SBP of 126mmHg (IQR 107-142), ISS of 9 (IQR 9-14) and GCS of 15 (IQR 15-15), were analysed. Multivariable logistic regression analysis adjusted for age, gender, severity of injury and level of consciousness showed a cut-off for SBP at <110mmHg, after which increased mortality was observed. Compared with the reference group with SBP 110-129mmHg, mortality was doubled at SBP 90-109mmHg, was four-fold higher at 70-89mmHg and 10-fold higher at <70mmHg. SBP values ≥150mmHg were associated with decreased mortality.
  
  
  CONCLUSIONS
  We recommend that penetrating trauma patients with a SBP<110mmHg are triaged to resuscitation areas within dedicated, appropriately specialised, high-level care trauma centres.
authors: Trauma Audit and Research Network, Health Sciences Research Group, School of Community Based Medicine, Manchester Academic Health Sciences Centre, University of Manchester, Salford Royal Hospital, Stott Lane, Salford M6 8HD, UK. rebecca.hasler@gmail.com
authors: Rebecca M
authors: RM
authors: Hasler
authors: Eveline
authors: E
authors: Nüesch
authors: Peter
authors: P
authors: Jüni
authors: Omar
authors: O
authors: Bouamra
authors: Aristomenis K
authors: AK
authors: Exadaktylos
authors: Fiona
authors: F
authors: Lecky
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001794:Blood Pressure; D001795:Blood Pressure Determination; D015984:Causality; D002423:Cause of Death; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007022:Hypotension / Q000175:diagnosis* / Q000401:mortality*; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D014193:Trauma Centers; D014218:Triage; D006113:United Kingdom; D014950:Wounds, Penetrating / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D055815:Young Adult