Prehospital hypotension as a valid indicator of trauma team activation

This retrospective study utilized the trauma registry of a Level I trauma center from July, 1993 through October, 1998. The trauma center involved has a large urban and rural patient referral base. The authors' hypothesis was that prehospital hypotension is not a valid indicator for trauma team activation. Of the 6,976 patients reviewed 4,437 had a prehospital blood pressure recorded. Hypotension was defined as a systolic blood pressure 90 mmHg. The presence of hypotension was determined by the use of the first blood pressure obtained in both the prehospital and emergency department settings. The patients were divided into four groups. Group 1 included patients with both prehospital and ED hypotension. Group 2 patients had prehospital hypotension, but a normal ED systolic blood pressure (SBP). Group 3 was comprised of patients with a normal prehospital SBP but ED hypotension. The final group, Group 4, had a normal prehospital and ED SBP. In the prehospital setting 791 patients had documented hypotension. Patients arriving with minimal or no signs of life and died immediately in the ED accounted for 193 (24%) of these patients. The group with the highest mortality rate (44% overall) was the group with prehospital hypotension that continued in the ED. In addition, 50 o/o of the patients with hypotension required direct admission to the operating room from the ED. Of the patients requiring either operative care or admission to a critical care unit 70% had documented hypotension The mortality rate for patients with prehospital hypotension ranged from 16- 44 o/o. In addition to evaluating the significance of prehospital hypotension the authors evaluated several other prehospital factors. The administration of intravenous fluid (IVF) resuscitation was reviewed. IVF had a minimal effect on the mortality rates in the hypotensive patient with penetrating trauma. Prehospital scene times and transport times were also reviewed. There were no statistically significant findings noted. The authors concluded that hypotension is a very sensitive indicator for the activation of the trauma team. Because of this study they changed the activation criteria for the trauma team at their facility. The system is now a single-tier trauma alert system. Abnormal vital signs for both blunt and penetrating trauma is the primary criteria for activation of the trauma team.