Oyetunji Tolulope A, Chang David C, Crompton Joseph G, Greene Wendy R, Efron David T, Haut Elliott R, Cornwell Edward E, Haider Adil H
Howard-Hopkins Surgical Outcomes Research Center, Department of Surgery, Howard University College of Medicine, Washington, DC 20060, USA.
Arch Surg. 2011 Jul;146(7):865-9. doi: 10.1001/archsurg.2011.154.
Recent debate concerns the most appropriate definition of hypotension. Some have advocated raising the systolic blood pressure (BP) threshold to 110 mm Hg while others favor 80 mm Hg.
The optimal definition of hypotension differs by age group.
An analysis was performed of trauma victims 18 years and older in the National Trauma Data Bank, excluding burn injury patients and those with incomplete data.
Injured patients who were hospitalized in various trauma centers across the continental United States.
Three age groups were identified for analysis as follows: 18 to 35 years, 36 to 64 years, and 65 years and older. One hundred one multiple logistic regression analyses were performed for each population. Hypotension was sequentially defined as an emergency department systolic BP (SBP) of 50 to 150 mm Hg to see which model best predicted mortality, adjusting for demographic and injury covariates. The discriminatory power of each model was measured using the area under the receiver operating characteristic (AUROC) curve. Optimally defined hypotension was identified as the model with the highest AUROC curve.
In-hospital mortality.
A total of 902,852 patients (median age, 44 years; 66.2% men) were analyzed. Overall mortality was 4.1%. Optimal emergency department SBP cutoff values for hypotension were 85 mm Hg for patients aged 18 to 35 years, 96 mm Hg for patients aged 36 to 64 years, and 117 mm Hg for elderly patients.
For patients younger than 65 years, the classic definition of hypotension as an emergency department SBP less than 90 mm Hg remains optimal. With increasing involvement of elderly individuals in trauma and their peculiarity as a comorbid state, there is a need to redefine what is presently defined as a cutoff value for hypotension in elderly patients.
近期的争论聚焦于低血压最恰当的定义。一些人主张将收缩压（BP）阈值提高到110毫米汞柱，而另一些人则倾向于80毫米汞柱。
低血压的最佳定义因年龄组而异。
对国家创伤数据库中18岁及以上的创伤患者进行分析，排除烧伤患者和数据不完整者。
美国大陆各地不同创伤中心住院的受伤患者。
确定了三个年龄组进行分析，分别为：18至35岁、36至64岁、65岁及以上。对每组人群进行了101次多元逻辑回归分析。将低血压依次定义为急诊科收缩压（SBP）为50至150毫米汞柱，以观察哪种模型最能预测死亡率，并对人口统计学和损伤协变量进行调整。使用受试者操作特征（AUROC）曲线下面积来衡量每个模型的辨别能力。将具有最高AUROC曲线的模型确定为最佳定义的低血压模型。
院内死亡率。
共分析了902,852例患者（中位年龄44岁；66.2%为男性）。总体死亡率为4.1%。低血压的最佳急诊科SBP临界值，18至35岁患者为85毫米汞柱，36至64岁患者为96毫米汞柱，老年患者为117毫米汞柱。
对于65岁以下的患者，将低血压定义为急诊科SBP低于90毫米汞柱的经典定义仍然是最佳的。随着老年人在创伤中所占比例的增加以及他们作为合并症状态的特殊性，有必要重新定义目前老年患者低血压的临界值。
