PURPOSE: Traditionally, systolic blood pressure below 90 mmHg is considered as unstable hemodynamics. However, recent studies suggested that SBP 90–110 mmHg may be indicative of hypoperfusion and associated with bad outcome. The purpose of this study was to evaluate initial hemodynamics in patients sustaining multiple traumas to identify ongoing internal bleeding.
METHODS: Demographic and clinical information were extracted from adult patients who sustained multiple injuries and underwent chest or abdominal computed tomography (CT) scans from January 2002 through July 2007. Extravasation of contrast material on CT scan was considered positive for ongoing internal bleeding. A statistical analysis was done using the Wilcoxon rank sum test and the Fisher's exact tests. Multivariate logistic regression analyses were performed to assess the association between bleeding and other factors.
RESULTS: A total of 113 consecutive patients were included in this study. Thirty five patients (31%) had CT scan evidence of ongoing bleeding. In comparing the patients with ongoing bleeding to those not bleeding, the two groups were similar in their gender, race, pulse and shock index. However, those bleeding patients had a significant higher age (mean [standard deviation]: 47.3 [21.1] vs. 37.2 [18.6] years, P=0.01), lower systolic blood pressure (117.0 [26.6] vs. 130.9 [29.4] mmHg, P=0.02) and higher Glasgow coma scale (GCS) (13.7 [3.4] vs. 12.0 [4.5], P=0.02). The injury severity score (ISS) is lower in the bleeding patients (22.4[12.5] vs. 27.4 [14.0], P=0.06). From multivariate logistic regression analysis, higher age (P=0.009) and lower SBP (P=0.007) are significantly associated with the bleeding group, when controlled for gender, race and GCS. From the same model, GCS has a moderate level of association (P=0.08). Among those ongoing bleeding patients, only 4 patients (11%) had SBP lower than 90 mmHg, and 49% had SBP higher than 120 mmHg.
CONCLUSION: Initial SBP of 120 mmHg cannot be considered as stable following multiple injuries.
CLINICAL IMPLICATIONS: Close hemodynamic monitoring and appropriate investigation should be entertained based on mechanism of injury to exclude the internal bleeding despite initial SBP of 120 mmHg.
DISCLOSURE: Daniel Kassavin, No Financial Disclosure Information; No Product/Research Disclosure Information