Association of Out-of-Hospital Hypotension Depth and Duration With Traumatic Brain Injury Mortality
AuthorSpaite, Daniel W
Bobrow, Bentley J
Gaither, Joshua B
Denninghoff, Kurt R
Adelson, P David
Keim, Samuel M
Rice, Amber D
AffiliationUniv 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
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CitationSpaite, 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.
JournalANNALS OF EMERGENCY MEDICINE
RightsCopyright © 2017 by the American College of Emergency Physicians.
Collection InformationThis 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 firstname.lastname@example.org.
AbstractStudy 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.
Note12 month embargo; published online: 27 May 2017
VersionFinal accepted manuscript
SponsorsNational Institute of Neurological Disorders and Stroke of the National Institutes of Health [R01NS071049]; NIH