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    Association of Out-of-Hospital Hypotension Depth and Duration With Traumatic Brain Injury Mortality

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    Name:
    Hypotension_DDD-Annals-REVISIO ...
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    Description:
    Final Accepted Manuscript
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    Author
    Spaite, Daniel W
    Hu, Chengcheng
    Bobrow, Bentley J
    Chikani, Vatsal
    Barnhart, Bruce
    Gaither, Joshua B
    Denninghoff, Kurt R
    Adelson, P David
    Keim, Samuel M
    Viscusi, Chad
    Mullins, Terry
    Rice, Amber D
    Sherrill, Duane
    Show allShow less
    Affiliation
    Univ Arizona, Coll Med, Arizona Emergency Med Res Ctr
    Univ Arizona, Phoenix Childrens Hosp, Barrow Neurol Inst
    Univ Arizona, Coll Med, Dept Child Hlth Neurosurg
    Univ Arizona, Coll Med, Dept Emergency Med
    Univ Arizona, Coll Publ Hlth
    Issue Date
    2017-10-01
    
    Metadata
    Show full item record
    Publisher
    MOSBY-ELSEVIER
    Citation
    Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Barnhart, B., Gaither, J. B., ... & Mullins, T. (2017). Association of out-of-hospital hypotension depth and duration with traumatic brain injury mortality. Annals of emergency medicine, 70(4), 522-530.
    Journal
    ANNALS OF EMERGENCY MEDICINE
    Rights
    Copyright © 2017 by the American College of Emergency Physicians.
    Collection Information
    This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at repository@u.library.arizona.edu.
    Abstract
    Study objective: Out-of-hospital hypotension has been associated with increased mortality in traumatic brain injury. The association of traumatic brain injury mortality with the depth or duration of out-of-hospital hypotension is unknown. We evaluated the relationship between the depth and duration of out-of-hospital hypotension and mortality in major traumatic brain injury. Methods: We evaluated adults and older children with moderate or severe traumatic brain injury in the preimplementation cohort of Arizona's statewide Excellence in Prehospital Injury Care study. We used logistic regression to determine the association between the depth-duration dose of hypotension (depth of systolic blood pressure <90 mm Hg integrated over duration [minutes] of hypotension) and odds of inhospital death, controlling for significant confounders. Results: There were 7,521 traumatic brain injury cases included (70.6% male patients; median age 40 years [interquartile range 24 to 58]). Mortality was 7.8% (95% confidence interval [CI] 7.2% to 8.5%) among the 6,982 patients without hypotension (systolic blood pressure >= 90 mm Hg) and 33.4% (95% CI 29.4% to 37.6%) among the 539 hypotensive patients(systolic blood pressure <90 mm Hg). Mortality was higher with increased hypotension dose: 0.01 to 14.99 mm Hg-minutes 16.3%; 15 to 49.99 mm Hg-minutes 28.1%; 50 to 141.99 mm Hg-minutes 38.8%; and greater than or equal to 142 mm Hg-minutes 50.4%. Log(2) (the logarithm in base 2) of hypotension dose was associated with traumatic brain injury mortality (adjusted odds ratio 1.19 [95% CI 1.14 to 1.25] per 2-fold increase of dose). Conclusion: In this study, the depth and duration of out-of-hospital hypotension were associated with increased traumatic brain injury mortality. Assessments linking out-of-hospital blood pressure with traumatic brain injury outcomes should consider both depth and duration of hypotension.
    Note
    12 month embargo; published online: 27 May 2017
    ISSN
    1097-6760
    PubMed ID
    28559036
    DOI
    10.1016/j.annemergmed.2017.03.027
    Version
    Final accepted manuscript
    Sponsors
    National Institute of Neurological Disorders and Stroke of the National Institutes of Health [R01NS071049]; NIH
    Additional Links
    https://www.sciencedirect.com/science/article/pii/S0196064417303232?via%3Dihub
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.annemergmed.2017.03.027
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