On-admission blood pressure and pulse rate in trauma patients and their correlation with mortality: Cushing's phenomenon revisited
Prashant Bhandarkar1, Ashok Munivenkatappa2, Nobhojit Roy3, Vineet Kumar4, Veda Dhruthy Samudrala5, Jyoti Kamble6, Amit Agrawal5
1 Department of Statistics, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
2 VRDLN Project, National Institute of Epidemiology (ICMR), Chennai, Tamil Nadu, India
3 Department of Surgery, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
4 Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
5 Department of Neurosurgery, Narayana Medical College Hospital, Nellore, Andhra Pradesh, India
6 Department of Surgery, Tata Institute of Social Sciences, Mumbai, Maharashtra, India
Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore - 524 003, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Background: Injury-induced alteration in initial physiological responses such as hypertension and heart rate (HR) has a significant effect on mortality. Research on such associations from our country-India is limited. The present study investigates the injury-induced early blood pressure (BP) and HR changes and their association with mortality.
Materials and Methods: The data were selected from Towards Improved Trauma Care Outcomes collected from October 1, 2013, to July 24, 2014. Patients above 18 years of age with documented systolic BP (SBP) and HR were selected. BP was categorized into hypotension (SBP <90 mmHg), hypertension (SBP >140 mmHg), and normal (SBP 90–140 mmHg). HR was categorized into bradycardia (HR <60 beats/min [bpm]), tachycardia (HR >100 bpm), and normal (HR 60–100 bpm). These categories were compared with mortality.
Results: A total of 10,200 patients were considered for the study. Mortality rate was 24%. Mortality among females was more than males. Patients with normal BP and HR had 20% of mortality. Mortality in patients with abnormal BP and HR findings was 36%. Mortality was higher among hypotension-bradycardia patients (80%) followed by hypertension-bradycardia patients (58%) and tachycardia hypotension patients (48%). Elderly patients were at higher risk of deaths with an overall mortality of 35% compared to 23% of adults.
Conclusion: The study reports that initial combination of hypotension-bradycardia had higher mortality rate. Specific precautions in prehospital care should be given to trauma patients with these findings. Further prospective study in detail should be considered for exploring this abnormality.