The impact of age and receipt antihypertensives to systolic blood pressure and shock index at injury scene and in the emergency department to predict massive transfusion in trauma patients

Author:

Park Se JinORCID,Lee Mi JinORCID,Kim ChanghoORCID,Jung HaewonORCID,Kim Seong HunORCID,Nho WooyoungORCID,Seo Kang SukORCID,Park JungbaeORCID,Ryoo Hyun WookORCID,Ahn Jae YunORCID,Moon SungbaeORCID,Cho Jae WanORCID,Son Shin-ahORCID

Abstract

Abstract Background Systolic blood pressure (SBP) and shock index (SI) are accurate indicators of hemodynamic instability and the need for transfusion in trauma patients. We aimed to determine whether the utility and cutoff point for SBP and SI are affected by age and antihypertensives. Methods This was a retrospective observational study of a level 1 trauma center between January 2017 and December 2018. We analyzed the utility and cutoff points of SBP and SI for predicting massive transfusion (MT) and 30-day mortality according to patients’ age and whether they were taking antihypertensives. A multivariable logistic regression analysis was conducted to estimate the association of age and antihypertensives on primary and secondary outcomes. Results We analyzed 4681 trauma cases. There were 1949 patients aged 65 years or older (41.6%), and 1375 hypertensive patients (29.4%). MT was given to 137 patients (2.9%). The 30-day mortality rate was 6.3% (n = 294). In geriatric trauma patients taking antihypertensives, a prehospital SBP less than 110 mmHg was the cutoff value for predicting MT in multivariate logistic regression analyses; packed red blood cell transfusion volume decreased abruptly based on prehospital SBP of 110 mmHg. Emergency Department SI greater than 1.0 was the cutoff value for predicting MT in patients who were older than 65 years and were not taking antihypertensives. Conclusions The triage of trauma patients is based on the identification of clinical features readily identifiable by first responders. However, age and medications may also affect the accurate evaluation. In initial trauma management, we must apply SBP and SI differently depending on age, whether a patient is taking antihypertensives, and the time at which the indicators are measured.

Publisher

Springer Science and Business Media LLC

Subject

Critical Care and Intensive Care Medicine,Emergency Medicine

Reference30 articles.

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