S. Asmar1, Z. Haddadin1, K. Hanna1, M. Khurrum1, A. Tang1, M. Ditillo1, M. Chehab1, B. Joseph1 1University of Arizona,Trauma Critical Care Burns And Emergency Surgery,Tucson, ARIZONA, USA
Introduction: Blood pressure alterations in patients with TBI have been shown to be associated with increased mortality. However, it is unclear what the optimal emergency department (ED) systolic blood pressure (SBP) target should be during the initial evaluation. The aim of our study was to assess the association between systolic blood pressure on presentation and mortality in TBI patients.
Methods: We performed a 2-year analysis (2015-2016) of the ACS-TQIP database and included all adult (age≥18y) trauma patients who had a TBI on presentation. The outcome measure was in-hospital mortality at different ED SBP values. A sub analysis based on TBI severity according to GCS was performed (mild (GCS≥13), moderate (GCS9-12), severe (≤8)). Multivariate logistic regression analysis was performed to control for confounding factors.
Results: A total of 124,854 adult trauma patients with TBI were included in the study. Mean age was 51±21y, 69.1% were male, and median GCS was 15 [12-15]. Mean SBP was 139.5±29.3 mmHg and overall morality was 9.6%. The lowest rate of mortality was noticed at ED SBP between 110-149 mmHg, while the highest mortality was at admission SBP < 90 mmHg and SBP > 190mmHg. On regression analysis, SBP between110-129mmHg (OR=0.77; p<0.01) and SBP between 130-149mmHg (OR=0.65; p<0.01) were associated with lower odds of mortality. On sub-analysis using logistic regression based on severity of TBI (mild 74.3%, moderate 6.1%, severe 19.5%) , patients with SBP between 110-129 mmHg were less likely to die across all TBI groups. Figure 1.
Conclusion: Based on this study, the optimal systolic blood pressure range for patients with TBI appears to be between 110-149 mmHg. This range might guide clinicians in developing resuscitation protocols for managing patients with TBI.
