Bruns Brandon, Gentilello Larry, Elliott Alan, Shafi Shahid
Department of Surgery, Division of Burns, Trauma, and Critical Care, University of Texas Southwestern Medical School, Parkland Memorial Hospital, Dallas, Texas, USA.
J Trauma. 2008 Dec;65(6):1217-21. doi: 10.1097/TA.0b013e318184ee63.
The American College of Surgeons Committee on Trauma suggests prehospital systolic blood pressure (PSBP) < 90 mm Hg as a criterion for triage of injured patients to trauma centers. However, Advanced Trauma Life Support recognizes this threshold as a late sign of shock. We undertook the current study to determine whether a higher PSBP threshold may identify patients at significant risk of death.
A retrospective analysis of an urban, Level I trauma center registry data was undertaken in patients with complete information on PSBP (n = 16,365; 1994-2003). Several thresholds of PSBP were chosen: < or = 60, < or = 70, < or = 80, < or = 90, < or = 100, and < or = 110 mm Hg, and the relationship between each threshold of PSBP and patient outcomes was explored. A p value < 0.05 was considered statistically significant.
Mean age of patients was 36 +/- 16 years, and 81% sustained a blunt injury. PSBP strongly correlated with systolic blood pressure obtained in the emergency department (Pearson r 0.65, p < 0.001). The risk of death increased sharply when PSBP dropped < 110 mm Hg, with nearly 1 in 10 (8%) dying in the emergency department and one in six (15%) dying eventually.
The definition of prehospital hypotension used for triage of injured patients to trauma centers should be redefined as PSBP < 110 mm Hg. The impact of this redefinition on trauma center resource utilization should be studied further.
美国外科医师学会创伤委员会建议，将院前收缩压（PSBP）<90mmHg作为创伤患者分诊至创伤中心的标准。然而，高级创伤生命支持将这一阈值视为休克的晚期征象。我们开展本研究以确定更高的PSBP阈值是否能识别出死亡风险显著的患者。
对一家城市一级创伤中心登记数据进行回顾性分析，纳入PSBP信息完整的患者（n = 16365；1994 - 2003年）。选择了几个PSBP阈值：≤60、≤70、≤80、≤90、≤100和≤110mmHg，并探讨每个PSBP阈值与患者结局之间的关系。p值<0.05被认为具有统计学意义。
患者的平均年龄为36±16岁，81%为钝性损伤。PSBP与急诊科测得的收缩压密切相关（Pearson相关系数r = 0.65，p < 0.001）。当PSBP降至<110mmHg时，死亡风险急剧增加，近十分之一（8%）的患者在急诊科死亡，六分之一（15%）的患者最终死亡。
用于将创伤患者分诊至创伤中心的院前低血压定义应重新定义为PSBP<110mmHg。这一定义对创伤中心资源利用的影响应进一步研究。
