title: The impact of arterial hypertension on polytrauma and traumatic brain injury.
abstract: BACKGROUND
  Pre-hospital hypotension in trauma patients is associated with high mortality. Especially for patients with severe traumatic brain injury (TBI), arterial normotension or even hypertension (AHT) is considered an important mechanism for sustaining adequate cerebral perfusion pressure. The effect of pre-hospital arterial hypertension (pAHT) on in-hospital mortality after trauma has not been studied to date.
  
  
  METHODS
  We retrospectively analyzed data in the trauma registry of the German Society for Trauma Surgery (DGU) on all trauma patients in Germany from 1993 to 2008 who were 16 to 80 years old at the time of the trauma and had an injury severity score (ISS) of 9 or above (total, 42 500 patient data sets). For the analysis, we divided the patients into two groups: those with and those without TBI. We further divided the TBI patients into five subgroups depending on the course of their systolic blood pressure up to the moment of their arrival at the hospital. We also analyzed the patients' demographic data, patterns of injury, and accident mechanisms.
  
  
  RESULTS
  Trauma patients with TBI and pAHT (142 of 561 patients) had a significantly higher mortality than normotensive TBI patients (25.3% vs. 13.5%, p<0.001). Arterial hypertension that either rises or falls before the patient reaches the hospital is associated with higher in-hospital mortality. A logistical regression analysis of 5384 patients revealed that patients with pAHT (n = 561) had an odds ratio of 1.9 (95% confidence interval, 1.4 to 1.6) for death in the hospital compared to normotensive patients (n = 6020).
  
  
  CONCLUSIONS
  Systolic blood pressure values above 160 mm Hg before arrival in the hospital worsen the outcome of trauma patients with TBI.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Ev.Krankenhaus Bethesda zu Duisburg gGmbH.
authors.forename: Timur
authors.initials: T
authors.lastname: Sellmann
authors.forename: Daniel
authors.initials: D
authors.lastname: Miersch
authors.forename: Peter
authors.initials: P
authors.lastname: Kienbaum
authors.forename: Sascha
authors.initials: S
authors.lastname: Flohé
authors.forename: Johannes
authors.initials: J
authors.lastname: Schneppendahl
authors.forename: Rolf
authors.initials: R
authors.lastname: Lefering
mesh_terms: D001930:Brain Injuries / Q000401:mortality*; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D006973:Hypertension / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000401:mortality*; D015995:Prevalence; D012042:Registries; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate