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Relationship of Mean Arterial Pressure with the Adverse Outcomes in Adult Blunt Trauma Patients: Cross-sectional Study  

Cha, Seung Yong (Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine)
Kim, Yong Hwan (Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine)
Hong, Chong Kun (Department of Emergency Medicine, Bundang Jesaeng General Hospital)
Lee, Jun Ho (Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine)
Cho, Kwang Won (Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine)
Hwang, Seong Youn (Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine)
Lee, Kyoung Yul (Department of Physical Education, Kyungnam University)
Lee, Younghwan (Department of Emergency Medicine, SHallym Sacred Heart Hospital, School of Medicine, Hallym University)
Choi, Seong Hee (Department of Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine)
Publication Information
Journal of Trauma and Injury / v.26, no.2, 2013 , pp. 39-46 More about this Journal
Abstract
Purpose: Non-invasive blood pressure measurement is widely used as a pre-hospital triage tool for blunt trauma patients. However, scant data exits for using the mean arterial pressure (MAP), compared to the systolic blood pressure, as a guiding index. The aim of this study was to determine the association between adverse outcomes and mean arterial pressure (MAP) and to exhibit the therapeutic range of the MAP in adult blunt trauma patients. Methods: The electronic medical records for all trauma patients in a single hospital from January 2010 to September 2012 were retrospectively reviewed. Patients below 17 years of age, patients with penetrating injuries, and patients with serious head trauma (injuries containing any skull fractures or any intracranial hemorrhages) were excluded. Adverse outcomes were defined as one of the following: death in the Emergency Department (ED), admission via operating theater, admission to the intensive care unit, transfer to another hospital for emergency surgery, or discharge as hopeless. Results: There were 14,537 patients who met entry criteria. Adverse outcomes occurred for MAPs in range from 90 to 120 mmHg. Adverse outcomes were found, after adjusting for confounding variables, to occur increasingly as the MAP declined below 90 mmHg or rose above 120 mmHg. Conclusion: Not only lower but also higher mean arterial pressure is associated with increased adverse outcomes in adult blunt trauma patients. Thus, patients with a MAP above 120 mmHg should be considered as a special group requiring higher medical attention, just as those with a MAP below 90 mmHg are.
Keywords
Mean arterial pressure; Triage; Blunt injury;
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1 Hasler RM, Nuesch E, Juni P, Bouamra O, Exadaktylos AK, Lecky F. Systolic blood pressure below 110 mm Hg is associated with increased mortality in blunt major trauma patients: multicentre cohort study. Resuscitation 2011; 82: 1202-7.   DOI
2 Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001; 345: 1368-77.   DOI
3 Rivers EP, Katranji M, Jaehne KA, Brown S, Abou Dagher G, Cannon C, et al. Early interventions in severe sepsis and septic shock: a review of the evidence one decade later. Minerva Anestesiol 2012; 78: 712-24.
4 Nee PA, Rivers EP. The end of the line for the Surviving Sepsis Campaign, but not for early goal-directed therapy. Emerg Med J 2011; 28: 3-4.   DOI
5 Turner J, Nicholl J, Webber L, Cox H, Dixon S, Yates D. A randomised controlled trial of prehospital intravenous fluid replacement therapy in serious trauma. Health Technol Assess 2000; 4: 1-57.
6 Rivers EP. Point: adherence to early goal-directed therapy: does it really matter? Yes. After a decade, the scientific proof speaks for itself. Chest 2010; 138: 476-80; discussion 84-5.   DOI
7 Bickell WH, Wall MJ, Jr., Pepe PE, Martin RR, Ginger VF, Allen MK, et al. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med 1994; 331: 1105-9.   DOI
8 Morrison CA, Carrick MM, Norman MA, Scott BG, Welsh FJ, Tsai P, et al. Hypotensive resuscitation strategy reduces transfusion requirements and severe postoperative coagulopathy in trauma patients with hemorrhagic shock: preliminary results of a randomized controlled trial. J Trauma 2011; 70: 652-63.   DOI
9 Available at: www.who.int/healthinfo/global_burden_disease/ en/ Aa. Accessed on Nov, 20. 2012.
10 OECD. Organisation for Economic Cooperation and Development. OECD Health Data 2007. Paris: OECD; 2007.
11 Kim S. [Epidemiology and control of injury]. J Prev Med Public Health 2005; 38: 125-31.
12 Moore FA, Moore EE, Sauaia A. Blood transfusion. An independent risk factor for postinjury multiple organ failure. Arch Surg 1997; 132: 620-4; discussion 4-5.   DOI
13 Sauaia A, Moore FA, Moore EE, Moser KS, Brennan R, Read RA, et al. Epidemiology of trauma deaths: a reassessment. J Trauma 1995; 38: 185-93.   DOI
14 Brohi K, Cohen MJ, Davenport RA. Acute coagulopathy of trauma: mechanism, identification and effect. Curr Opin Crit Care 2007; 13: 680-5.   DOI
15 Tieu BH, Holcomb JB, Schreiber MA. Coagulopathy: its pathophysiology and treatment in the injured patient. World J Surg 2007; 31: 1055-64.   DOI
16 Sasser SM, Hunt RC, Sullivent EE, Wald MM, Mitchko J, Jurkovich GJ, et al. Guidelines for field triage of injured patients. Recommendations of the National Expert Panel on Field Triage. MMWR Recomm Rep 2009; 58: 1-35.
17 Parks JK, Elliott AC, Gentilello LM, Shafi S. Systemic hypotension is a late marker of shock after trauma: a validation study of Advanced Trauma Life Support principles in a large national sample. Am J Surg 2006; 192: 727-31.   DOI
18 Available at: http://www.nda.ox.ac.uk/wfsa/html/u10/u1002_ 03.htm. Accessed January. 20.
19 157-159. PLMABPIPLMTIBreLWW.
20 Guly HR, Bouamra O, Little R, Dark P, Coats T, Driscoll P, et al. Testing the validity of the ATLS classification of hypovolaemic shock. Resuscitation 2010; 81: 1142-7.   DOI
21 McMahon CG, Kenny R, Bennett K, Little R, Kirkman E. The effect of acute traumatic brain injury on the performance of shock index. J Trauma 2010; 69: 1169-75.   DOI
22 Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the Trauma Score. J Trauma 1989; 29: 623-9.   DOI
23 Kim Y, Jung KY, Kim CY, Kim YI, Shin Y. Validation of the International Classification of Diseases 10th Edition-based Injury Severity Score (ICISS). J Trauma 2000; 48: 280-5.   DOI