The association between admission systolic blood pressure and mortality in significant traumatic brain injury: A multi-centre cohort study

Fuller, Gordon; Hasler, Rebecca M.; Mealing, Nicole; Lawrence, Thomas; Woodford, Maralyn; Jüni, Peter; Lecky, Fiona

doi:10.1016/j.injury.2013.09.008

Cited by 84 publications

(42 citation statements)

References 37 publications

(37 reference statements)

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“…Several authors have reported that elevated blood pressure was related to poor outcomes in traumatic brain injury (TBI). Additionally, Zafar et al and Fuller et al specifically mentioned that mortality in TBI showed a bimodal distribution [33–36]. In the general trauma population, the association between hypertension and mortality is not clearly known.…”

Section: Discussionmentioning

confidence: 99%

The new trauma score (NTS): a modification of the revised trauma score for better trauma mortality prediction

et al. 2017

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BackgroundSince its introduction, the Revised Trauma Score (RTS) has been widely used to determine the prognosis of trauma patients. Recent studies have revealed a need to change the parameters of the RTS. We have designed a new trauma score (NTS) based on revised parameters, including the adoption of the actual Glasgow Coma Scale (GCS) score instead of a GCS code, the revision of the systolic blood pressure interval used for the code value and the incorporation of peripheral oxygen saturation (SpO2) instead of respiratory rate. The purpose of this study was to evaluate the predictive performance of the NTS for in-hospital mortality compared with the RTS and other trauma scores.MethodsThis was a prospective observational study using data from the trauma registry of a tertiary hospital. The subjects were selected from patients who arrived at the ED between July 1, 2014, and June 30, 2016, and, for external validation purposes, those who arrived at the ED between July 1, 2011, and June 30, 2013. Demographic data and physiological data were analyzed. NTS models were calculated using logistic regression for GCS score, SBP code values, and SpO2. The mortality predictive performance of NTS was compared with that of other trauma scores.ResultsA total of 3263 patients for derivation and 3106 patients for validation were included in the analysis. The NTS showed better discrimination than the RTS (AUC = 0.935 vs. 0.917, respectively, AUC difference = 0.018, p = 0.001; 95% CI, 0.0071–0.0293) and similar discrimination to that of mechanism, Glasgow Coma scale, age, and arterial pressure (MGAP) and the Glasgow Coma Scale, age, and systolic arterial pressure (GAP). In the validation cohort, the global properties of the NTS for mortality prediction were significantly better than those of the RTS (AUC = 0.919 vs. 0.906, respectively; AUC difference = 0.013, p = 0.013; 95% CI, 0.0009–0.0249) and similar to those of the MGAP and GAP.ConclusionsThe NTS predicts in-hospital mortality substantially better than the RTS.

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Section: Discussionmentioning

confidence: 99%

The new trauma score (NTS): a modification of the revised trauma score for better trauma mortality prediction

et al. 2017

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“…The BTF prehospital guidelines recommend treating hypotensive patients with isotonic fluids, with the option of hypertonic fluids for patients with GCS <8 [15]. However, it should be noted that a more recent multicenter cohort study analysis incorporating 5057 patients with significant TBI has suggested that having an admission SBP even below 120 mmHg may increase mortality rates [21]. …”

Section: Prehospital Managementmentioning

confidence: 99%

Medical Management of the Severe Traumatic Brain Injury Patient

et al. 2017

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Severe traumatic brain injury (sTBI) is a major contributor to long term disability and a leading cause of death worldwide. Medical management of the sTBI patient, beginning with pre-hospital triage, is aimed at preventing secondary brain injury. This review discusses prehospital and emergency department management of severe TBI, as well as aspects of TBI management in the intensive care unit where advances have been made in the past decade. Areas of emphasis include intracranial pressure management, neuromonitoring, management of paroxysmal sympathetic hyperactivity, neuroprotective strategies, prognostication, and communication with families about goals of care. Where appropriate, differences between the third and fourth editions of the Brain Trauma Foundation Guidelines for the Management of Severe Traumatic Brain Injury are highlighted.

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“…In patients with traumatic brain injury, the odds of death are 1.5 times greater at SBP < 120 mm Hg, double at <100 mm Hg, triple at <90 mm Hg, and 6 times greater at SBP <70 mm Hg. 18 Balancing cerebral perfusion pressure targets with the goal of decreasing bleeding until definitive hemorrhage control in these patients is a challenge for the most experienced trauma anesthesiologist. The practice of pharmacologic resuscitation is also advancing rapidly and may include antifibrinolytics, 19 procoagulants, 20 replacement of endogenous vasopressin, 21 and correcting hypocalcemia.…”

Section: Traumamentioning

confidence: 99%