SBP >100mmHg: 83 (72 96) – SBP <100mmHg: 88 (72 110) – (Stated values from blunt trauma patients. Similar pattern seen in subset with penetrating .) Bouamra O Outcome TARN 1996 2001 New model included age, gender, GCS Regarding SBP and RR: is not – “That et al 2006 prediction in N = 100399 and ISS. to say that these variables have no trauma value in the acute clinical situation, Designed to develop an Adding SBP and RR did not improve the merely that within our dataset once alternative to TRISS scoring ability of the model to discriminate the patient’s age, gender, GCS and system to alleviate the problem between survivors and non-survivors. ISS are known SBP and RR add of commonly missing variables. nothing further to mortality prediction.” Fuller G et al The association TARN 2005-12 Mortality risk increased significantly TBI treatment guidelines, “Current 2014 between below SBP of 120 using a cut-off for hypotension at admission systolic >16 years (both crude and for SBP<90mmHg should be blood pressure Significant TBI AIS confounders) reconsidered” ≥3 and mortality in N = 5057 significant ISS 21 traumatic brain Age 48.7 injury: a Mortality 12.9% cohort study Primary outcome 30 day mortality how does admission – SBP influence this? Hasler R et SBP<110mmHg TARN (2000-2009) Mortality rose significantly SBP of recommend that all penetrating “We al 2012 is associated with Excluded: blunt/TBI/transfers 110mmHg, independent of age, gender, trauma patients with a SBP increased from non-TARN hospitals. GCS and ISS. <110mmHg should be triaged to mortality in 71% stabbing/10% shooting/6% resuscitation areas within penetrating trauma each fall, MVA, other dedicated…high level trauma patients: centres” Multicentre cohort N = 3444 study. Median ISS 9 Primary outcome 30 day mortality how does admission – SBP influence this?
SBP >100mmHg: 83 (72 – 96) SBP <100mmHg: 88 (72 – 110) (Stated values from blunt trauma patients. Similar pattern seen in subset with penetrating .) Bouamra O et al 2006 Outcome prediction in trauma TARN 1996 – 2001 N = 100399 Designed to develop an alternative to TRISS scoring system to alleviate the problem of commonly missing variables. New model included age, gender, GCS and ISS. Adding SBP and RR did not improve the ability of the model to discriminate between survivors and non-survivors. Regarding SBP and RR: “That is not to say that these variables have no value in the acute clinical situation, merely that within our dataset once the patient’s age, gender, GCS and ISS are known SBP and RR add nothing further to mortality prediction.” Fuller G et al 2014 The association between admission systolic blood pressure and mortality in significant traumatic brain injury: a cohort study TARN 2005-12 >16 years Significant TBI AIS ≥3 N = 5057 ISS 21 Age 48.7 Mortality 12.9% Primary outcome 30 day mortality – how does admission SBP influence this? Mortality risk increased significantly below SBP of 120 (both crude and for confounders) “Current TBI treatment guidelines, using a cut-off for hypotension at SBP<90mmHg should be reconsidered” Hasler R et al 2012 SBP<110mmHg is associated with increased mortality in penetrating trauma patients: Multicentre cohort study. TARN (2000-2009) Excluded: blunt/TBI/transfers from non-TARN hospitals. 71% stabbing/10% shooting/6% each fall, MVA, other N = 3444 Median ISS 9 Primary outcome 30 day mortality – how does admission SBP influence this? Mortality rose significantly SBP of 110mmHg, independent of age, gender, GCS and ISS. “We recommend that all penetrating trauma patients with a SBP <110mmHg should be triaged to resuscitation areas within dedicated…high level trauma centres”