Narrow pulse pressure is independently associated with massive transfusion and emergent surgery in hemodynamically stable trauma patients

Bankhead, Brittany K.; Teixeira, Pedro G.R.; Roward, Simin; Ali, Sádia; Ryder, Alexa; Sahi, Saad L.; Cardenas, Tatiana; Aydelotte, Jayson; Coopwood, Ben; Brown, Cvr

doi:10.1016/j.amjsurg.2020.06.042

Cited by 10 publications

(5 citation statements)

References 17 publications

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“…Severely undertriaged patients had higher initial systolic blood pressure in the field (137 [118-150] vs 116 [88-143] mmHg, P < .001) and in the ED (131 [116-149] vs 123 [76-148] mmHg, P < .001). Glasgow Coma Scale was also higher among SU patients (in the field, 15 [14][15] vs 6 [3][4][5][6][7][8][9][10][11][12][13][14], P < .001 and in the ED, 15 [14][15] vs 6 [3][4][5][6][7][8][9][10][11][12][13][14], P < .001). Severely undertriaged patients had a lower median ISS than AT patients (29 [26-30] vs 32 [27-41], P < .001).…”

Section: Resultsmentioning

confidence: 88%

“…10,11 Pulse pressure is an additional metric that may allow for the prehospital identification of patients who are otherwise stable but still stand to benefit from early mobilization of trauma center personnel and resources. Narrow pulse pressure in the field has been shown to indicate the likelihood of significant hemorrhage 12 and predicts the need for massive transfusion 13 and emergent intervention 14 in otherwise stable trauma patients. Other suggested potential metrics to improve triage fidelity include prehospital lactate 15 and shock index.…”

Section: Discussionmentioning

confidence: 99%

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Undertriage of Severely Injured Trauma Patients

Anderson

Schellenberg

Owattanapanich

et al. 2023

The American Surgeon™

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Introduction The American College of Surgeons (ACS) delineates trauma team activation (TTA) criteria to identify seriously injured trauma patients in the field. Patients are deemed to be severely undertriaged (SU), placing them at risk for adverse outcomes, when they do not meet TTA criteria but nonetheless sustain significant injuries (Injury Severity Score [ISS] ≥25). Objectives Delineate patient demographics, injuries, and outcomes after SU. Participants Trauma patients presenting to our ACS-verified Level 1 trauma center with ISS ≥25 were included (11/2015-03/2022). Transfers and private vehicle transports were excluded. Patients were dichotomized and compared by trauma arrival level: TTA (Appropriately Triaged, AT) vs routine consults (SU). Results Study criteria were satisfied by 1653 patients: 1375 (83%) AT and 278 (17%) SU. Severely undertriaged patients were older than AT patients (47 vs 36 years, P < .001). Severely undertriaged occurred almost exclusively following blunt trauma (96% vs 71%, P < .001). Injury Severity Score was lower following SU than AT (29 vs 32, P < .001). The most common severe injuries (Abbreviated Injury Scale score [AIS] ≥3) among the SU group were in the Chest (n = 179, 64%). Severely undertriaged patients necessitated emergent intubation (n = 34, 12%), surgery (n = 59, 21%), and angioembolization (n = 22, 8%) at high rates. Severely undertriaged mortality was n = 40, 14%. Conclusion Severely undertriaged occurred among a substantial proportion of ISS ≥25 patients, predominately following blunt trauma. Severe chest injuries were most likely to evade capture. Rates of intubation, emergent intervention, and in-hospital mortality were high after SU. Efforts should be made to identify such patients in the field as they may benefit from TTA.

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Section: Resultsmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Undertriage of Severely Injured Trauma Patients

Anderson

Schellenberg

Owattanapanich

et al. 2023

The American Surgeon™

View full text Add to dashboard Cite

show abstract

“…Zhu et al reported that the combination of shock index and pulse pressure can effectively predict the need for blood transfusion [26]. As the available datasets unfortunately did not include diastolic blood pressure values, pulse pressure as an additional parameter could not be analysed, although it could be easily assessed in both the prehospital and in hospital settings and it is an independent factor associated with the need for massive transfusion [27].…”

Section: Discussionmentioning

confidence: 99%

Patients at Risk for Transfusion—A Six-Year Multicentre Analysis of More Than 320,000 Helicopter Emergency Medical Service Missions

Jänig,

Willms,

Schwietring

et al. 2023

JCM

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Background. In Europe, ambulances are increasingly being equipped with blood products for prehospital use. Available evidence on the early administration of blood products comes from military medicine and the Anglo-American medical literature; the evidence cannot be easily transferred to European countries. Objectives. This study assesses the incidence of patients with massive haemorrhage after trauma and the potential need for prehospital blood transfusions. Methods. Data reported by 37 German air rescue stations between 2015 and 2020 were retrospectively analysed to predict the need for massive transfusion. Results. A total of 320,347 helicopter emergency medical service (HEMS) missions were performed and involved 2982 patients with potential need for massive transfusion after trauma (approximately 13 transfusions per helicopter per year). Men were most affected (73%). The median age of patients was 38 years. Traffic accidents accounted for 59% of the cases. Most patients sustained multiple injuries including traumatic brain injuries (62%), as well as thoracic (54%), abdominal (39%), and extremity injuries (41%). The median “rSIG” (reversed shock index multiplied with the Glasgow Coma Scale) decreased from 4.31 to 3.78. Conclusions. Although the incidence of haemorrhagic trauma patients is low, the prehospital administration of blood products might be useful as a potentially life-saving bridging treatment until hospital admission.

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“…8 Hypotension, as determined by low systolic blood pressure (SBP), is a well-documented indicator of ongoing blood loss requiring emergent therapeutic intervention. 6 In the setting of trauma, hypotension hastens clinical decision-making, and yields early intervention such as blood transfusion [9][10][11] and operative intervention. 12 If medical staff can identify the condition of traumatic massive hemorrhage early, intervene quickly, and actively adjust the treatment strategy, the disability and mortality rate due to massive traumatic hemorrhage may be reduced, and outcomes of severe trauma may be improved.…”

Section: Introductionmentioning

confidence: 99%

Pulse Pressure: A Predictor of Intervention in Blunt Abdominal Trauma

Salman

Laeeque

Jawaid

et al. 2023

Preprint

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Background: Patients with life-threatening hemorrhage due to blunt torso trauma are at a particularly high risk of being under-diagnosed. The pulse pressure starts narrowing down before the traditional parameters start changing, making it a useful tool for assessing and planning early intervention. Objective: Toassess the utility of low pulse pressure in predicting massive transfusion or operative intervention in patients with isolated blunt torso trauma. Material and Methods: total of 186 patients were included. The pulse pressure and mean arterial pressure were calculated. Vitals, pulse pressure, and mean arterial pressure were monitored every 15 min during the first 6 h, then every 30 min during the next 6 h and afterwards, every 4 h until discharge. Chi-square test and an independent t-test (as appropriate) were applied to compare variables with pulse pressure at the time of presentation. A Differences were considered as statistically significant at p-value ≤ 0.05. Results: total of 55.9% of these patients had injuries due to road traffic accidents. Emergency operative intervention was provided to 26.3% of the patients. Death was 4.3%. Massive transfusion was required by 26.3% of the patients. There was a statistically significant association between low pulse pressure and sex, length of stay, repeat eFAST, emergency operational intervention, outcome, massive transfusion, number of crystalloids consumed within the first four hours after presentation, injury severity score, systolic blood pressure, and pulse rate. Conclusion: The pulse pressure <30 mmHg was observed as an independent predictor for increased blood loss requiring blood transfusion or operative intervention.

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Narrow pulse pressure is independently associated with massive transfusion and emergent surgery in hemodynamically stable trauma patients

Cited by 10 publications

References 17 publications

Undertriage of Severely Injured Trauma Patients

Undertriage of Severely Injured Trauma Patients

Patients at Risk for Transfusion—A Six-Year Multicentre Analysis of More Than 320,000 Helicopter Emergency Medical Service Missions

Pulse Pressure: A Predictor of Intervention in Blunt Abdominal Trauma

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