Severe traumatic brain injury and hypotension is a frequent and lethal combination in multiple trauma patients in mountain areas - an analysis of the prospective international Alpine Trauma Registry
Simon Rauch, Matilde Marzolo, Tomas Dal Cappello, Mathias Ströhle, Peter Mair, Urs Pietsch, Hermann Brugger, Giacomo Strapazzon & IATR Study Group
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abstract
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BACKGROUND
Hypotension is associated with worse outcome in patients with
traumatic brain injury (TBI) and maintaining a systolic blood
pressure (SBP) ≥110 mmHg is recommended. The aim of this
study was to assess the incidence of TBI in patients suffering
multiple trauma in mountain areas; to describe associated factors,
treatment and outcome compared to non-hypotensive patients with TBI
and patients without TBI; and to evaluate pre-hospital variables to
predict admission hypotension.
METHODS
Data from the prospective International Alpine Trauma Registry
including mountain multiple trauma patients
(ISS ≥ 16) collected between 2010 and 2019 were
analysed. Patients were divided into three groups: 1) TBI with
hypotension, 2) TBI without hypotension and 3) no TBI. TBI was
defined as Abbreviated Injury Scale (AIS) of the head/neck ≥3 and
hypotension as SBP < 110 mmHg on hospital
arrival.
RESULTS
A total of 287 patients were included. Fifty (17%) had TBI and
hypotension, 92 (32%) suffered TBI without hypotension and 145 (51%)
patients did not have TBI. Patients in group 1 were more severely
injured (mean ISS 43.1 ± 17.4 vs
33.3 ± 15.3 vs 26.2 ± 18.1
for group 1 vs 2 vs 3, respectively, p < 0.001). Mean
SBP on hospital arrival was 83.1 ± 12.9 vs
132.5 ± 19.4 vs
119.4 ± 25.8 mmHg
(p < 0.001) despite patients in group 1 received more
fluids. Patients in group 1 had higher INR, lower haemoglobin and
lower base excess (p < 0.001). More than one third of
patients in group 1 and 2 were hypothermic (body
temperature < 35 °C) on hospital arrival
while the rate of admission hypothermia was low in patients without
TBI (41% vs 35% vs 21%, for group 1 vs 2 vs 3,
p = 0.029). The rate of hypothermia on hospital arrival
was different between the groups (p = 0.029). Patients
in group 1 had the highest mortality (24% vs 10% vs 1%,
p < 0.001).
CONCLUSION
Multiple trauma in the mountains goes along with severe TBI in
almost 50%. One third of patients with TBI is hypotensive on
hospital arrival and this is associated with a worse outcome. No
single variable or set of variables easily obtainable at scene was
able to predict admission hypotension in TBI patients.
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citation
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Rauch S, Marzolo M, Cappello T D, Ströhle M, Mair P, Pietsch U,
Brugger H, Strapazzon G, IATR Study Group . Severe traumatic brain
injury and hypotension is a frequent and lethal combination in
multiple trauma patients in mountain areas - an analysis of the
prospective international Alpine Trauma Registry. Scand J Trauma
Resusc Emerg Med 2021; 29:61.
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type
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journal paper/review (English)
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date of publishing
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30-04-2021
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journal title
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Scand J Trauma Resusc Emerg Med (29/1)
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ISSN electronic
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1757-7241
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pages
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61
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PubMed
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33931076
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DOI
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10.1186/s13049-021-00879-1
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