» Articles » PMID: 33931076

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

Overview
Publisher Biomed Central
Specialty Emergency Medicine
Date 2021 May 1
PMID 33931076
Citations 8
Authors
Affiliations
Soon will be listed here.
Abstract

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.

Citing Articles

TERMINAL-24 Score in Predicting Early and In-hospital Mortality of Trauma Patients; a Cross-sectional.

Ashrafian Fard S, Ahmadi S, Ebrahimi Bakhtavar H, Sadeghi Bazargani H, Rahmani F Arch Acad Emerg Med. 2025; 13(1):e25.

PMID: 39958961 PMC: 11829243. DOI: 10.22037/aaemj.v13i1.2526.


Eight rules for the haemodynamic management of traumatic brain-injured patients.

Di Filippo S, Messina A, Pelosi P, Robba C Eur J Anaesthesiol Intensive Care. 2025; 2(4):e0029.

PMID: 39917068 PMC: 11783677. DOI: 10.1097/EA9.0000000000000029.


Comparison of the lethal triad and the lethal diamond in severe trauma patients: a multicenter cohort.

Dupuy C, Martinez T, Duranteau O, Gauss T, Kapandji N, Pasqueron J World J Emerg Surg. 2025; 20(1):2.

PMID: 39773274 PMC: 11705660. DOI: 10.1186/s13017-024-00572-5.


Hypotension and Adverse Outcomes in Moderate to Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis.

Lee J, Wang W, Rezk A, Mohammed A, Macabudbud K, Englesakis M JAMA Netw Open. 2024; 7(11):e2444465.

PMID: 39527054 PMC: 11555550. DOI: 10.1001/jamanetworkopen.2024.44465.


Mortality-Associated Factors in a Traumatic Brain Injury Population in Mexico.

Martinez-Herrera E, Galindo-Oseguera E, Castillo-Cruz J, Fuentes-Venado C, Gasca-Lopez G, Calzada-Mendoza C Biomedicines. 2024; 12(9).

PMID: 39335550 PMC: 11428733. DOI: 10.3390/biomedicines12092037.


References
1.
Pietsch U, Strapazzon G, Ambuhl D, Lischke V, Rauch S, Knapp J . Challenges of helicopter mountain rescue missions by human external cargo: need for physicians onsite and comprehensive training. Scand J Trauma Resusc Emerg Med. 2019; 27(1):17. PMC: 6374883. DOI: 10.1186/s13049-019-0598-2. View

2.
Sessler D . Perioperative thermoregulation and heat balance. Lancet. 2016; 387(10038):2655-2664. DOI: 10.1016/S0140-6736(15)00981-2. View

3.
Timm A, Maegele M, Lefering R, Wendt K, Wyen H . Pre-hospital rescue times and actions in severe trauma. A comparison between two trauma systems: Germany and the Netherlands. Injury. 2014; 45 Suppl 3:S43-52. DOI: 10.1016/j.injury.2014.08.017. View

4.
Barton C, Hemphill J, Morabito D, Manley G . A novel method of evaluating the impact of secondary brain insults on functional outcomes in traumatic brain-injured patients. Acad Emerg Med. 2005; 12(1):1-6. DOI: 10.1197/j.aem.2004.08.043. View

5.
Gupta B, Garg N, Ramachandran R . Vasopressors: Do they have any role in hemorrhagic shock?. J Anaesthesiol Clin Pharmacol. 2017; 33(1):3-8. PMC: 5374828. DOI: 10.4103/0970-9185.202185. View