Prehospital hypotension has been utilized for decades as a surrogate marker of injury severity. Several studies have discussed the correlation between injury and hypotension both in the field as well as in the emergency department. Increases have been noted in injury severity score and mortality. Resource utilization is higher in this patient population. This study revisits our original work from 2000 and reviews the current literature regarding hypotension and injury severity. We also examine the role of prehospital hypotension as an indicator of trauma team activation and resource allocation. This review serves as a part of a Literary Festschrift in honor of Dr J David Richardson’s role as the Editor-in-Chief of The American Surgeon.
FranklinGABoazPWSpainDA, et al.Prehospital hypotension as a valid indicator of trauma team activation. J Trauma. 2000;48(6):1034-1039.
2.
Committee on Trauma of the American College of Surgeons. Resources for Optimal Care of the Injured Patient: 2014. Chicago, IL: American College of Surgeons; 2014:38-42.
3.
FriesGRMcCallaGLevittMACordovaR. A prospective comparison of paramedic judgment and the trauma triage rule in the prehospital setting. Ann Emerg Med. 1994;24:885-889.
4.
EspositoTJOffnerPJJurkowichGJGriffithJMaierRV. Do prehospital trauma center triage criteria identify major trauma victims?Arch Surg. 1995;130:171-176.
5.
ChanLBartfieldJMReillyKM. The significance of out of hospital hypotension in blunt trauma patients. Acad Emerg Med. 1997;4:785-788.
6.
DammeCDLuoJBuesingKL. Isolated prehospital hypotension correlates with injury severity and outcomes in patients with trauma. Trauma Surg Acute Care Open. 2016;1(1):e000013. doi: 10.1136/tsaco-2016-000013
7.
KristensenAKHollerJGMikkelsenSHallasJLassenA. Systolic blood pressure and short-term mortality in the emergency department and prehospital setting: A hospital-based cohort study. Crit Care Open Access. 2015;19(1):158.
8.
HaslerRMNüeschEJüniP, et al.Systolic blood pressure below 110 mmHg is associated with increased mortality in penetrating major trauma patients: Multicentre cohort study. Resuscitation. 2012;83(4):476-481.
9.
SpaiteDWHuCBobrowBJ, et al.Mortality and prehospital blood pressure in major traumatic brain injury: The absence of a hypotension threshold. JAMA Surg. 2017;152(4):360-368.
10.
SpaiteDWHuCBobrowBJ, et al.The impact of combined prehospital hypotension and hypoxia on mortality in major traumatic brain injury. Ann Emerg Med. 2017;69(1):62-72.
11.
SasserSMHuntRCFaulM, et al.Guidelines for field triage of injured patients: Recommendations of the National Expert Panel on Field Triage, 2011. Centers for Disease Control and Prevention, MMWR. 2012;61(RR01):1-20.
LipskyAMGausche-HillMHennemanPL, et al.Prehospital hypotension is a predictor of the need for an emergent, therapeutic operation in trauma patients with normal systolic blood pressure in the emergency department. J Trauma. 2006;61(5):1228-1233.
14.
NewgardCDRudserKHedgesJR, et al.A critical assessment of the out-of-hospital trauma triage guidelines for physiologic abnormality. J Trauma. 2010;68(2):452-462.
15.
VandrommeMJGriffinRLWeinbergJARueLWIIIKerbyJD. Lactate is a better predictor than systolic blood pressure for determining blood requirement and mortality: Could prehospital measures improve trauma triage?J Am Coll Surg. 2010;210(5):861-867.
16.
EastridgeBJSalinasJMcManusJG, et al.Hypotension begins at 110 mm Hg: redefining “hypotension” with data. J Trauma. 2007;63:291-299.
17.
HaslerRMNueschEJüniP, et al.Systolic blood pressure below 110 mm Hg is associated with increased mortality in blunt major trauma patients: Multicentre cohort study. Resuscitation. 2011;82(9):1202-1207.
18.
MackersieRC. History of trauma field triage development and the American College of Surgeons criteria. Prehosp Emerg Care. 2006;10:287-294.
19.
LalezarzadehFWisniewskiPHuynhK, et al.Evaluation of prehospital and emergency department systolic blood pressure as a predictor of in-hospital mortality. Am Surg. 2009;75(10):1009-1014.
20.
LeichtleSWPoulosNGWhelanJAboutanosM. Field triage of motor vehicle crashes: Which factors predict high injury severity?Am Surg. 2019;85(7):764-767.
