The association between admission systolic blood pressure and mortality in significant traumatic brain injury: A multi-centre cohort study

Fuller, Gordon; Hasler, Rebecca M; Mealing, Nicole; Lawrence, Thomas; Woodford, Maralyn; Jüni, Peter; Lecky, Fiona (2014). The association between admission systolic blood pressure and mortality in significant traumatic brain injury: A multi-centre cohort study. Injury - international journal of the care of the injured, 45(3), pp. 612-7. Elsevier 10.1016/j.injury.2013.09.008

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INTRODUCTION

Low systolic blood pressure (SBP) is an important secondary insult following traumatic brain injury (TBI), but its exact relationship with outcome is not well characterised. Although a SBP of <90mmHg represents the threshold for hypotension in consensus TBI treatment guidelines, recent studies suggest redefining hypotension at higher levels. This study therefore aimed to fully characterise the association between admission SBP and mortality to further inform resuscitation endpoints.

METHODS

We conducted a multicentre cohort study using data from the largest European trauma registry. Consecutive adult patients with AIS head scores >2 admitted directly to specialist neuroscience centres between 2005 and July 2012 were studied. Multilevel logistic regression models were developed to examine the association between admission SBP and 30 day inpatient mortality. Models were adjusted for confounders including age, severity of injury, and to account for differential quality of hospital care.

RESULTS

5057 patients were included in complete case analyses. Admission SBP demonstrated a smooth u-shaped association with outcome in a bivariate analysis, with increasing mortality at both lower and higher values, and no evidence of any threshold effect. Adjusting for confounding slightly attenuated the association between mortality and SBP at levels <120mmHg, and abolished the relationship for higher SBP values. Case-mix adjusted odds of death were 1.5 times greater at <120mmHg, doubled at <100mmHg, tripled at <90mmHg, and six times greater at SBP<70mmHg, p<0.01.

CONCLUSIONS

These findings indicate that TBI studies should model SBP as a continuous variable and may suggest that current TBI treatment guidelines, using a cut-off for hypotension at SBP<90mmHg, should be reconsidered.

Item Type:

 Journal Article (Original Article)

Division/Institute:

 04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)
04 Faculty of Medicine > Pre-clinic Human Medicine > Department of Clinical Research (DCR)
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > University Emergency Center

UniBE Contributor:

 Hasler, Rebecca Maria, Mealing, Nicole, Jüni, Peter

Subjects:

 600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

 0020-1383

Publisher:

 Elsevier

Language:

 English

Submitter:

 Doris Kopp Heim

Date Deposited:

 15 Feb 2014 14:53

Last Modified:

 20 Feb 2024 14:17

Publisher DOI:

 10.1016/j.injury.2013.09.008

PubMed ID:

 24206920

Additional Information:

Fuller and Hasler contributed equally to this work.

Uncontrolled Keywords:

 Craniocerebral trauma Hypotension Resuscitation Systolic blood pressure

BORIS DOI:

 10.7892/boris.41394

URI:

 https://boris.unibe.ch/id/eprint/41394

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