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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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.


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.


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.


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)


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


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








Doris Kopp Heim

Date Deposited:

15 Feb 2014 14:53

Last Modified:

20 Feb 2024 14:17

Publisher DOI:


PubMed ID:


Additional Information:

Fuller and Hasler contributed equally to this work.

Uncontrolled Keywords:

Craniocerebral trauma Hypotension Resuscitation Systolic blood pressure




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