Field hypotension in patients who arrive at the hospital normotensive

a marker of severe injury or crying wolf?

Paul J. Schenarts, Sachin V. Phade, Steven Agle, Claudia E. Goettler, Scott G. Sagraves, Mark A. Newell, Michael F. Rotondo

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

INTRODUCTION: Trauma patients with hypotension in the field who arrive at a hospital with a normal blood pressure (BP) may not be recognized as significantly injured. METHODS: Over a 5-year period, demographic, injury severity, and disposition data were retrospectively analyzed for patients > or =16 years of age with documented hypotension in the field (systolic BP <or =90 mm Hg) and normal BP (systolic BP >90 mmHg) on hospital arrival (hypotensive group). This group was compared to patients with normal BP in the field and on hospital arrival (normotensive group). RESULTS: During the study, 2207 patients with documented BP were transported directly from the scene. Of this number 44 (2%) were assigned to the hypotensive group, 2086 (94%) were assigned to the normotensive group, and 77 (4%) patients were hypotensive on hospital arrival. The hypotensive group had a systolic BP in the field of 70 +/- 26 mmHg compared to 140 +/- 26 mmHg in the normotensive group (p <0.0001). Arrival BP at the hospital was normal in both groups. Compared to the normotensive group, the hypotensive group had higher Injury Severity Scores (22.0 vs. 11.1, p <0.0001), lower Glasgow Coma Scores (10.8 vs. 14.0, p <0.0001), lower Revised Trauma Scores (65 vs. 7.4, p <0.0O01), more emergency department deaths (7% vs. 0%, p <0.001), longer lengths of stay in the intensive care unit (8.6 vs. 7.0 days, p <0.0001) and hospital (14.0 vs. 7.0 days, p <0.0001), and increased hospital mortality (18% vs. 4%, p <0.001). LIMITATIONS: The retrospective design and exclusion of patients without documentation of BP in the field may have resulted in selection bias. CONCLUSION: Despite these limitations, field hypotension is a marker of significant injury in patients arriving at the hospital normotensive.

Original languageEnglish (US)
Pages (from-to)265-269
Number of pages5
JournalNorth Carolina Medical Journal
Volume69
Issue number4
StatePublished - Jul 2008
Externally publishedYes

Fingerprint

Hypotension
Blood Pressure
Wounds and Injuries
Mobile Health Units
Injury Severity Score
Selection Bias
Coma
Hospital Mortality
Documentation
Intensive Care Units
Hospital Emergency Service
Length of Stay
Demography

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Schenarts, P. J., Phade, S. V., Agle, S., Goettler, C. E., Sagraves, S. G., Newell, M. A., & Rotondo, M. F. (2008). Field hypotension in patients who arrive at the hospital normotensive: a marker of severe injury or crying wolf? North Carolina Medical Journal, 69(4), 265-269.

Field hypotension in patients who arrive at the hospital normotensive : a marker of severe injury or crying wolf? / Schenarts, Paul J.; Phade, Sachin V.; Agle, Steven; Goettler, Claudia E.; Sagraves, Scott G.; Newell, Mark A.; Rotondo, Michael F.

In: North Carolina Medical Journal, Vol. 69, No. 4, 07.2008, p. 265-269.

Research output: Contribution to journalArticle

Schenarts, PJ, Phade, SV, Agle, S, Goettler, CE, Sagraves, SG, Newell, MA & Rotondo, MF 2008, 'Field hypotension in patients who arrive at the hospital normotensive: a marker of severe injury or crying wolf?', North Carolina Medical Journal, vol. 69, no. 4, pp. 265-269.
Schenarts PJ, Phade SV, Agle S, Goettler CE, Sagraves SG, Newell MA et al. Field hypotension in patients who arrive at the hospital normotensive: a marker of severe injury or crying wolf? North Carolina Medical Journal. 2008 Jul;69(4):265-269.
Schenarts, Paul J. ; Phade, Sachin V. ; Agle, Steven ; Goettler, Claudia E. ; Sagraves, Scott G. ; Newell, Mark A. ; Rotondo, Michael F. / Field hypotension in patients who arrive at the hospital normotensive : a marker of severe injury or crying wolf?. In: North Carolina Medical Journal. 2008 ; Vol. 69, No. 4. pp. 265-269.
@article{dec1831da61a415fb15613ce433cb930,
title = "Field hypotension in patients who arrive at the hospital normotensive: a marker of severe injury or crying wolf?",
abstract = "INTRODUCTION: Trauma patients with hypotension in the field who arrive at a hospital with a normal blood pressure (BP) may not be recognized as significantly injured. METHODS: Over a 5-year period, demographic, injury severity, and disposition data were retrospectively analyzed for patients > or =16 years of age with documented hypotension in the field (systolic BP 90 mmHg) on hospital arrival (hypotensive group). This group was compared to patients with normal BP in the field and on hospital arrival (normotensive group). RESULTS: During the study, 2207 patients with documented BP were transported directly from the scene. Of this number 44 (2{\%}) were assigned to the hypotensive group, 2086 (94{\%}) were assigned to the normotensive group, and 77 (4{\%}) patients were hypotensive on hospital arrival. The hypotensive group had a systolic BP in the field of 70 +/- 26 mmHg compared to 140 +/- 26 mmHg in the normotensive group (p <0.0001). Arrival BP at the hospital was normal in both groups. Compared to the normotensive group, the hypotensive group had higher Injury Severity Scores (22.0 vs. 11.1, p <0.0001), lower Glasgow Coma Scores (10.8 vs. 14.0, p <0.0001), lower Revised Trauma Scores (65 vs. 7.4, p <0.0O01), more emergency department deaths (7{\%} vs. 0{\%}, p <0.001), longer lengths of stay in the intensive care unit (8.6 vs. 7.0 days, p <0.0001) and hospital (14.0 vs. 7.0 days, p <0.0001), and increased hospital mortality (18{\%} vs. 4{\%}, p <0.001). LIMITATIONS: The retrospective design and exclusion of patients without documentation of BP in the field may have resulted in selection bias. CONCLUSION: Despite these limitations, field hypotension is a marker of significant injury in patients arriving at the hospital normotensive.",
author = "Schenarts, {Paul J.} and Phade, {Sachin V.} and Steven Agle and Goettler, {Claudia E.} and Sagraves, {Scott G.} and Newell, {Mark A.} and Rotondo, {Michael F.}",
year = "2008",
month = "7",
language = "English (US)",
volume = "69",
pages = "265--269",
journal = "North Carolina Medical Journal",
issn = "0029-2559",
publisher = "North Carolina Medical Society",
number = "4",

}

TY - JOUR

T1 - Field hypotension in patients who arrive at the hospital normotensive

T2 - a marker of severe injury or crying wolf?

AU - Schenarts, Paul J.

AU - Phade, Sachin V.

AU - Agle, Steven

AU - Goettler, Claudia E.

AU - Sagraves, Scott G.

AU - Newell, Mark A.

AU - Rotondo, Michael F.

PY - 2008/7

Y1 - 2008/7

N2 - INTRODUCTION: Trauma patients with hypotension in the field who arrive at a hospital with a normal blood pressure (BP) may not be recognized as significantly injured. METHODS: Over a 5-year period, demographic, injury severity, and disposition data were retrospectively analyzed for patients > or =16 years of age with documented hypotension in the field (systolic BP 90 mmHg) on hospital arrival (hypotensive group). This group was compared to patients with normal BP in the field and on hospital arrival (normotensive group). RESULTS: During the study, 2207 patients with documented BP were transported directly from the scene. Of this number 44 (2%) were assigned to the hypotensive group, 2086 (94%) were assigned to the normotensive group, and 77 (4%) patients were hypotensive on hospital arrival. The hypotensive group had a systolic BP in the field of 70 +/- 26 mmHg compared to 140 +/- 26 mmHg in the normotensive group (p <0.0001). Arrival BP at the hospital was normal in both groups. Compared to the normotensive group, the hypotensive group had higher Injury Severity Scores (22.0 vs. 11.1, p <0.0001), lower Glasgow Coma Scores (10.8 vs. 14.0, p <0.0001), lower Revised Trauma Scores (65 vs. 7.4, p <0.0O01), more emergency department deaths (7% vs. 0%, p <0.001), longer lengths of stay in the intensive care unit (8.6 vs. 7.0 days, p <0.0001) and hospital (14.0 vs. 7.0 days, p <0.0001), and increased hospital mortality (18% vs. 4%, p <0.001). LIMITATIONS: The retrospective design and exclusion of patients without documentation of BP in the field may have resulted in selection bias. CONCLUSION: Despite these limitations, field hypotension is a marker of significant injury in patients arriving at the hospital normotensive.

AB - INTRODUCTION: Trauma patients with hypotension in the field who arrive at a hospital with a normal blood pressure (BP) may not be recognized as significantly injured. METHODS: Over a 5-year period, demographic, injury severity, and disposition data were retrospectively analyzed for patients > or =16 years of age with documented hypotension in the field (systolic BP 90 mmHg) on hospital arrival (hypotensive group). This group was compared to patients with normal BP in the field and on hospital arrival (normotensive group). RESULTS: During the study, 2207 patients with documented BP were transported directly from the scene. Of this number 44 (2%) were assigned to the hypotensive group, 2086 (94%) were assigned to the normotensive group, and 77 (4%) patients were hypotensive on hospital arrival. The hypotensive group had a systolic BP in the field of 70 +/- 26 mmHg compared to 140 +/- 26 mmHg in the normotensive group (p <0.0001). Arrival BP at the hospital was normal in both groups. Compared to the normotensive group, the hypotensive group had higher Injury Severity Scores (22.0 vs. 11.1, p <0.0001), lower Glasgow Coma Scores (10.8 vs. 14.0, p <0.0001), lower Revised Trauma Scores (65 vs. 7.4, p <0.0O01), more emergency department deaths (7% vs. 0%, p <0.001), longer lengths of stay in the intensive care unit (8.6 vs. 7.0 days, p <0.0001) and hospital (14.0 vs. 7.0 days, p <0.0001), and increased hospital mortality (18% vs. 4%, p <0.001). LIMITATIONS: The retrospective design and exclusion of patients without documentation of BP in the field may have resulted in selection bias. CONCLUSION: Despite these limitations, field hypotension is a marker of significant injury in patients arriving at the hospital normotensive.

UR - http://www.scopus.com/inward/record.url?scp=55249112319&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=55249112319&partnerID=8YFLogxK

M3 - Article

VL - 69

SP - 265

EP - 269

JO - North Carolina Medical Journal

JF - North Carolina Medical Journal

SN - 0029-2559

IS - 4

ER -