title: Elevated admission systolic blood pressure after blunt trauma predicts delayed pneumonia and mortality.
abstract: BACKGROUND
  Although avoiding hypotension is a primary focus after trauma, elevated systolic blood pressure (SBP) is frequently disregarded. The purpose of this study was to determine the association between elevated admission SBP and delayed outcomes after trauma.
  
  
  METHODS
  The Los Angeles County Trauma System Database was queried for all patients between 2003 and 2008 with blunt injuries who survived for at least 2 days after admission. Demographics and outcomes (pneumonia and mortality) were compared at various admission SBP subgroups (≥160 mm Hg, ≥170 mm Hg, ≥180 mm Hg, ≥190 mm Hg, ≥200 mm Hg, ≥210 mm Hg, and ≥220 mm Hg). Patients with moderate-to-severe traumatic brain injury (TBI), defined as head Abbreviated Injury Score ≥3, were then identified and compared with those without using multivariable logistic regression.
  
  
  RESULTS
  Data accessed from 14,382 blunt trauma admissions identified 2,601 patients with moderate-to-severe TBI (TBI group) and 11,781 without moderate-to-severe TBI (non-TBI group) who were hospitalized ≥2 days. Overall mortality was 2.9%, 7.1% for TBI patients, and 1.9% for non-TBI patients. Overall pneumonia was 4.6%, 9.5% for TBI patients, and 3.6% for non-TBI patients. Regression modeling determined SBP ≥160 mm Hg was a significant predictor of mortality in TBI patients (adjusted odds ratio [AOR], 1.59; confidence interval [CI], 1.10-2.29; p = 0.03) and non-TBI patients (AOR, 1.47; CI, 1.14-1.90; p = 0.003). Similarly, SBP ≥160 mm Hg was a significant predictor for increased pneumonia in TBI patients (AOR, 1.79; CI, 1.30-2.46; p = 0.0004), compared with non-TBI patients (AOR, 1.28; CI, 0.97-1.69; p = 0.08).
  
  
  CONCLUSIONS
  In blunt trauma patients with or without TBI, elevated admission SBP was associated with worse delayed outcomes. Prospective research is necessary to determine whether algorithms that manage elevated blood pressure after trauma, especially after TBI, affect mortality or pneumonia.
authors.affiliation: Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA. eric.ley@cshs.org
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Ley
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Singer
authors.forename: Morgan A
authors.initials: MA
authors.lastname: Clond
authors.forename: Alexandra
authors.initials: A
authors.lastname: Gangi
authors.forename: Jim
authors.initials: J
authors.lastname: Mirocha
authors.forename: Marko
authors.initials: M
authors.lastname: Bukur
authors.forename: Carlos V
authors.initials: CV
authors.lastname: Brown
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D001795:Blood Pressure Determination; D001930:Brain Injuries / Q000150:complications / Q000175:diagnosis / Q000401:mortality; D015331:Cohort Studies; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D016489:Head Injuries, Closed / Q000150:complications / Q000175:diagnosis* / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis* / Q000401:mortality*; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010343:Patient Admission; D011014:Pneumonia / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D014193:Trauma Centers