J Korean Soc Emerg Med.  2015 Jun;26(3):240-247. 10.0000/jksem.2015.26.3.240.

Factors Affecting at 30 Days Mortality after Admission in Severe Trauma patients with Initial Hypotension in the Emergency Department: A Single Center Study

• Mun YS
• Sung WY
• Kwon OS
• Lee MK
• Lee JY
• Seo SW

• KMID: 2334022
• DOI: http://doi.org/10.0000/jksem.2015.26.3.240

Abstract

PURPOSE
Early assessment of injury severity is important in management of major trauma patients. In general, hypotensive major trauma patients show more severe outcomes from injuries compared with normotensive major trauma patients. In this study, we analyzed the clinical features of severe trauma patients with initial hypotension and attempted to determine the prognostic factors of mortality in these patients.
METHODS
A retrospective study was conducted within our hospital. Review of trauma registry data identified 679 major trauma patients (Injury severity score, ISS>15). From January 2011 to December 2013, all major trauma patients with initial systolic blood pressure lower than 90 mmHg were included (N=77). The patients were divided into two groups - those who survived and those who expired - and the differences in initial and final values were compared between the two groups.
RESULTS
Out of a total of 77 patients, 55 patients survived and 22 patients died. The data showed almost no difference in heart rate between the two groups. The expired group showed low Glasgow Coma Scale (GCS) score, systolic blood pressure, revised trauma score, initial pH, and follow-up pH, as well as higher age, ISS, initial lactate, prothrombin time (PT), international normalized ration (INR), and follow-up lactate, compared with the survived group. In multivariate logistic analysis, age (p=0.034, OR 1.071), GCS (p=0.006, OR 0.61), initial base excess (p=0.042, OR 0.57), and follow-up base excess (p=0.041, OR 0.799) were independently associated with mortality.
CONCLUSION
The patient's age, initial GCS, initial base excess and follow-up values of base excess were good prognostic factors for mortality in the expired major trauma patients with initial hypotension.

Keyword

Multiple trauma; Hypotension; Mortality

MeSH Terms

Blood Pressure
Emergency Service, Hospital*
Follow-Up Studies
Glasgow Coma Scale
Heart Rate
Humans
Hydrogen-Ion Concentration
Hypotension*
Lactic Acid
Mortality*
Multiple Trauma
Prothrombin Time
Retrospective Studies
Lactic Acid