Significance of a hypotensive episode following traumatic injury: A retrospective observational study.

Abstract

Background: Early hemodynamic assessment remains crucial for proper management in trauma settings. Hypotension is a vital indication in trauma patients to be considered upon initial triaging to assess the risk of bleeding and hypovolemic shock which entails significant clinical attention during initial resuscitation.

Aim: To assess whether an initial episode of prehospital or emergency department hypotension is associated with an increased risk of morbidity and mortality in trauma patients.

Methods: A retrospective analysis was performed to include all trauma patients hospitalized between 2011 and 2021. Hypotension was defined as a systolic blood pressure ≤ 90 mmHg in the prehospital setting or upon arrival to the hospital. Patients were classified into normotensive vs hypotensive and survivors vs non-survivors. Data was analyzed and compared, and multivariable logistic regression analysis was performed to identify the predictors of mortality.

Results: Over the ten years, 17341 trauma admissions were analyzed, of which 1188 (6.9%) patients had hypotension episodes either at the scene or upon hospital arrival. Patients with hypotension were two years younger (P = 0.001) in age and were more likely to have higher pulse rate (P = 0.001), elevated shock index (P = 0.001), sustained more severe injuries, frequently required blood transfusion and laparotomy, and had higher complications and mortality rates. Multivariable regression analysis identified hypotension [adjusted odds ratio (aOR) = 2.505; 95% confidence interval (95%CI) = 1.798-3.489; P = 0.001] and acute respiratory distress syndrome (ARDS; aOR = 5.482; 95%CI = 3.297-9.116; P = 0.001) as independent predictors of mortality. Among hypotensive trauma patients, only ARDS (aOR = 3.518; 95%CI = 1.385-7.204; P = 0.006) was significantly associated with mortality.

Conclusion: Hypotensive episodes following trauma are associated with higher severity and mortality. The development of ARDS is an independent predictor of mortality in hypotensive trauma patients. A hypotensive episode is a warning sign and calls for aggressive, timely management following trauma.