Eric J Ley, Matthew B Singer, Morgan A Clond, Alexandra Gangi, Jim Mirocha, Marko Bukur, Carlos V Brown, Ali Salim
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Patients with moderate-to-severe traumatic brain injury (TBI), defined as head Abbreviated Injury Score ≥3, were then identified and compared with those without using multivariable logistic regression.</p><p><strong>Results: </strong>Data accessed from 14,382 blunt trauma admissions identified 2,601 patients with moderate-to-severe TBI (TBI group) and 11,781 without moderate-to-severe TBI (non-TBI group) who were hospitalized ≥2 days. Overall mortality was 2.9%, 7.1% for TBI patients, and 1.9% for non-TBI patients. Overall pneumonia was 4.6%, 9.5% for TBI patients, and 3.6% for non-TBI patients. Regression modeling determined SBP ≥160 mm Hg was a significant predictor of mortality in TBI patients (adjusted odds ratio [AOR], 1.59; confidence interval [CI], 1.10-2.29; p = 0.03) and non-TBI patients (AOR, 1.47; CI, 1.14-1.90; p = 0.003). Similarly, SBP ≥160 mm Hg was a significant predictor for increased pneumonia in TBI patients (AOR, 1.79; CI, 1.30-2.46; p = 0.0004), compared with non-TBI patients (AOR, 1.28; CI, 0.97-1.69; p = 0.08).</p><p><strong>Conclusions: </strong>In blunt trauma patients with or without TBI, elevated admission SBP was associated with worse delayed outcomes. Prospective research is necessary to determine whether algorithms that manage elevated blood pressure after trauma, especially after TBI, affect mortality or pneumonia.</p>","PeriodicalId":48894,"journal":{"name":"Journal of Trauma-Injury Infection and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/TA.0b013e31823cc5df","citationCount":"25","resultStr":"{\"title\":\"Elevated admission systolic blood pressure after blunt trauma predicts delayed pneumonia and mortality.\",\"authors\":\"Eric J Ley, Matthew B Singer, Morgan A Clond, Alexandra Gangi, Jim Mirocha, Marko Bukur, Carlos V Brown, Ali Salim\",\"doi\":\"10.1097/TA.0b013e31823cc5df\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Although avoiding hypotension is a primary focus after trauma, elevated systolic blood pressure (SBP) is frequently disregarded. 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引用次数: 25
摘要
背景:虽然避免低血压是创伤后的首要重点，但收缩压升高经常被忽视。本研究的目的是确定入院时收缩压升高与创伤后延迟预后之间的关系。方法:查询洛杉矶县外伤系统数据库中2003年至2008年间所有入院后存活至少2天的钝性损伤患者。比较不同入院收缩压亚组(≥160 mm Hg、≥170 mm Hg、≥180 mm Hg、≥190 mm Hg、≥200 mm Hg、≥210 mm Hg和≥220 mm Hg)的人口统计学和结局(肺炎和死亡率)。采用多变量logistic回归，将定义为头部简易损伤评分≥3的中重度创伤性脑损伤(TBI)患者与非TBI患者进行比较。结果:从14,382例钝性创伤入院患者中获得的数据确定，住院≥2天的2,601例中至重度TBI (TBI组)和11,781例无中至重度TBI(非TBI组)。总体死亡率为2.9%，TBI患者为7.1%，非TBI患者为1.9%。总体肺炎发生率为4.6%，TBI患者为9.5%，非TBI患者为3.6%。回归模型确定收缩压≥160 mm Hg是TBI患者死亡率的显著预测因子(校正优势比[AOR]， 1.59;置信区间[CI]， 1.10-2.29;p = 0.03)和非脑外伤患者(AOR, 1.47;CI, 1.14 - -1.90;P = 0.003)。同样，收缩压≥160 mm Hg是TBI患者肺炎增加的重要预测因子(AOR, 1.79;CI, 1.30 - -2.46;p = 0.0004)，与非tbi患者相比(AOR, 1.28;CI, 0.97 - -1.69;P = 0.08)。结论:在伴有或不伴有TBI的钝性创伤患者中，入院时收缩压升高与较差的延迟预后相关。为了确定处理创伤后血压升高的算法是否会影响死亡率或肺炎，有必要进行前瞻性研究。
Elevated admission systolic blood pressure after blunt trauma predicts delayed pneumonia and mortality.
Background: Although avoiding hypotension is a primary focus after trauma, elevated systolic blood pressure (SBP) is frequently disregarded. The purpose of this study was to determine the association between elevated admission SBP and delayed outcomes after trauma.
Methods: The Los Angeles County Trauma System Database was queried for all patients between 2003 and 2008 with blunt injuries who survived for at least 2 days after admission. Demographics and outcomes (pneumonia and mortality) were compared at various admission SBP subgroups (≥160 mm Hg, ≥170 mm Hg, ≥180 mm Hg, ≥190 mm Hg, ≥200 mm Hg, ≥210 mm Hg, and ≥220 mm Hg). Patients with moderate-to-severe traumatic brain injury (TBI), defined as head Abbreviated Injury Score ≥3, were then identified and compared with those without using multivariable logistic regression.
Results: Data accessed from 14,382 blunt trauma admissions identified 2,601 patients with moderate-to-severe TBI (TBI group) and 11,781 without moderate-to-severe TBI (non-TBI group) who were hospitalized ≥2 days. Overall mortality was 2.9%, 7.1% for TBI patients, and 1.9% for non-TBI patients. Overall pneumonia was 4.6%, 9.5% for TBI patients, and 3.6% for non-TBI patients. Regression modeling determined SBP ≥160 mm Hg was a significant predictor of mortality in TBI patients (adjusted odds ratio [AOR], 1.59; confidence interval [CI], 1.10-2.29; p = 0.03) and non-TBI patients (AOR, 1.47; CI, 1.14-1.90; p = 0.003). Similarly, SBP ≥160 mm Hg was a significant predictor for increased pneumonia in TBI patients (AOR, 1.79; CI, 1.30-2.46; p = 0.0004), compared with non-TBI patients (AOR, 1.28; CI, 0.97-1.69; p = 0.08).
Conclusions: In blunt trauma patients with or without TBI, elevated admission SBP was associated with worse delayed outcomes. Prospective research is necessary to determine whether algorithms that manage elevated blood pressure after trauma, especially after TBI, affect mortality or pneumonia.
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