Pulse Pressure as an Early Warning of Hemorrhage in Trauma Patients
Background: Hypotension based on low systolic blood pressure (SBP) is a well-documented indicator of ongoing blood loss. However, the utility of pulse pressure (PP) for detection of hemorrhage has not been well studied. The purpose of this study was to determine whether a narrowed PP in nonhypotensi...
Ausführliche Beschreibung
Gespeichert in:
| Autor*in: |
Priestley, Erika M. [verfasserIn] Inaba, Kenji [verfasserIn] Byerly, Saskya [verfasserIn] Biswas, Subarna [verfasserIn] Wong, Monica D. [verfasserIn] Lam, Lydia [verfasserIn] Benjamin, Elizabeth [verfasserIn] Demetriades, Demetrios [verfasserIn] |
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| Format: |
E-Artikel |
|---|---|
| Sprache: |
Englisch |
| Erschienen: |
2019 |
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| Übergeordnetes Werk: |
Enthalten in: Journal of the American College of Surgeons - American College of Surgeons ; ID: gnd/5696-0, New York, NY : Elsevier, 1997, 229, Seite 184-191 |
|---|---|
| Übergeordnetes Werk: |
volume:229 ; pages:184-191 |
| DOI / URN: |
10.1016/j.jamcollsurg.2019.03.021 |
|---|
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ELV002621665 |
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| 245 | 1 | 0 | |a Pulse Pressure as an Early Warning of Hemorrhage in Trauma Patients |
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| 520 | |a Background: Hypotension based on low systolic blood pressure (SBP) is a well-documented indicator of ongoing blood loss. However, the utility of pulse pressure (PP) for detection of hemorrhage has not been well studied. The purpose of this study was to determine whether a narrowed PP in nonhypotensive patients is an independent predictor of critical administration threshold (CAT+) hemorrhage requiring surgical or endovascular control.Study Design: We performed a retrospective single-center study (January 2010 to October 2014), including trauma patients ≥16 years old with SBP ≥ 90 mmHg upon emergency department (ED) admission. We identified patients who were both CAT+ and required either surgical or interventional radiology for definitive hemorrhage control as the active hemorrhage (AH) group. Analyses were then performed to elucidate the association between PP and hemorrhage.Results: Of the total 18,015 patients identified, 283 (1.6%) met the criteria for clinically significant hemorrhage. Mean PP was significantly lower in the AH group compared with the non-AH group (39 ± 18 mmHg vs 53 ± 19 mmHg, p < 0.0001). Multivariate analysis revealed that narrowed initial ED PP is an independent predictor of AH (adjusted odds ratio [AOR] 0.975) along with age (AOR 1.01), penetrating mechanism (AOR 9.476), field SBP (AOR 0.985), ED heart rate (AOR 1.024), and Injury Severity Score (AOR 1.126). Cutoff analysis of PP values identified a significantly higher risk of AH at a PP cutoff of 55 mmHg (AOR 3.44, p = 0.005, AUC 0.955) in patients 61 years or older vs 40 mmHg (AOR 2.73, p < 0.0001, AUC 0.940) for patients 16 to 60 years old. The predicted probability of AH increases as PP narrows.Conclusions: In patients who are nonhypotensive, a narrowed PP is an independent early predictor of active hemorrhage requiring blood product transfusion and intervention for hemorrhage control. | ||
| 700 | 1 | |a Inaba, Kenji |e verfasserin |4 aut | |
| 700 | 1 | |a Byerly, Saskya |e verfasserin |4 aut | |
| 700 | 1 | |a Biswas, Subarna |e verfasserin |4 aut | |
| 700 | 1 | |a Wong, Monica D. |e verfasserin |4 aut | |
| 700 | 1 | |a Lam, Lydia |e verfasserin |4 aut | |
| 700 | 1 | |a Benjamin, Elizabeth |e verfasserin |4 aut | |
| 700 | 1 | |a Demetriades, Demetrios |e verfasserin |4 aut | |
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10.1016/j.jamcollsurg.2019.03.021 doi (DE-627)ELV002621665 (ELSEVIER)S1072-7515(19)30256-X DE-627 ger DE-627 rda eng 610 DE-600 44.65 bkl Priestley, Erika M. verfasserin aut Pulse Pressure as an Early Warning of Hemorrhage in Trauma Patients 2019 nicht spezifiziert zzz rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: Hypotension based on low systolic blood pressure (SBP) is a well-documented indicator of ongoing blood loss. However, the utility of pulse pressure (PP) for detection of hemorrhage has not been well studied. The purpose of this study was to determine whether a narrowed PP in nonhypotensive patients is an independent predictor of critical administration threshold (CAT+) hemorrhage requiring surgical or endovascular control.Study Design: We performed a retrospective single-center study (January 2010 to October 2014), including trauma patients ≥16 years old with SBP ≥ 90 mmHg upon emergency department (ED) admission. We identified patients who were both CAT+ and required either surgical or interventional radiology for definitive hemorrhage control as the active hemorrhage (AH) group. Analyses were then performed to elucidate the association between PP and hemorrhage.Results: Of the total 18,015 patients identified, 283 (1.6%) met the criteria for clinically significant hemorrhage. Mean PP was significantly lower in the AH group compared with the non-AH group (39 ± 18 mmHg vs 53 ± 19 mmHg, p < 0.0001). Multivariate analysis revealed that narrowed initial ED PP is an independent predictor of AH (adjusted odds ratio [AOR] 0.975) along with age (AOR 1.01), penetrating mechanism (AOR 9.476), field SBP (AOR 0.985), ED heart rate (AOR 1.024), and Injury Severity Score (AOR 1.126). Cutoff analysis of PP values identified a significantly higher risk of AH at a PP cutoff of 55 mmHg (AOR 3.44, p = 0.005, AUC 0.955) in patients 61 years or older vs 40 mmHg (AOR 2.73, p < 0.0001, AUC 0.940) for patients 16 to 60 years old. The predicted probability of AH increases as PP narrows.Conclusions: In patients who are nonhypotensive, a narrowed PP is an independent early predictor of active hemorrhage requiring blood product transfusion and intervention for hemorrhage control. Inaba, Kenji verfasserin aut Byerly, Saskya verfasserin aut Biswas, Subarna verfasserin aut Wong, Monica D. verfasserin aut Lam, Lydia verfasserin aut Benjamin, Elizabeth verfasserin aut Demetriades, Demetrios verfasserin aut Enthalten in American College of Surgeons ; ID: gnd/5696-0 Journal of the American College of Surgeons New York, NY : Elsevier, 1997 229, Seite 184-191 Online-Ressource (DE-627)320594459 (DE-600)2019367-1 (DE-576)118488945 1879-1190 nnns volume:229 pages:184-191 GBV_USEFLAG_U SYSFLAG_U GBV_ELV SSG-OLC-PHA GBV_ILN_31 GBV_ILN_2004 GBV_ILN_2011 GBV_ILN_2336 GBV_ILN_4305 44.65 Chirurgie AR 229 184-191 |
| spelling |
10.1016/j.jamcollsurg.2019.03.021 doi (DE-627)ELV002621665 (ELSEVIER)S1072-7515(19)30256-X DE-627 ger DE-627 rda eng 610 DE-600 44.65 bkl Priestley, Erika M. verfasserin aut Pulse Pressure as an Early Warning of Hemorrhage in Trauma Patients 2019 nicht spezifiziert zzz rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: Hypotension based on low systolic blood pressure (SBP) is a well-documented indicator of ongoing blood loss. However, the utility of pulse pressure (PP) for detection of hemorrhage has not been well studied. The purpose of this study was to determine whether a narrowed PP in nonhypotensive patients is an independent predictor of critical administration threshold (CAT+) hemorrhage requiring surgical or endovascular control.Study Design: We performed a retrospective single-center study (January 2010 to October 2014), including trauma patients ≥16 years old with SBP ≥ 90 mmHg upon emergency department (ED) admission. We identified patients who were both CAT+ and required either surgical or interventional radiology for definitive hemorrhage control as the active hemorrhage (AH) group. Analyses were then performed to elucidate the association between PP and hemorrhage.Results: Of the total 18,015 patients identified, 283 (1.6%) met the criteria for clinically significant hemorrhage. Mean PP was significantly lower in the AH group compared with the non-AH group (39 ± 18 mmHg vs 53 ± 19 mmHg, p < 0.0001). Multivariate analysis revealed that narrowed initial ED PP is an independent predictor of AH (adjusted odds ratio [AOR] 0.975) along with age (AOR 1.01), penetrating mechanism (AOR 9.476), field SBP (AOR 0.985), ED heart rate (AOR 1.024), and Injury Severity Score (AOR 1.126). Cutoff analysis of PP values identified a significantly higher risk of AH at a PP cutoff of 55 mmHg (AOR 3.44, p = 0.005, AUC 0.955) in patients 61 years or older vs 40 mmHg (AOR 2.73, p < 0.0001, AUC 0.940) for patients 16 to 60 years old. The predicted probability of AH increases as PP narrows.Conclusions: In patients who are nonhypotensive, a narrowed PP is an independent early predictor of active hemorrhage requiring blood product transfusion and intervention for hemorrhage control. Inaba, Kenji verfasserin aut Byerly, Saskya verfasserin aut Biswas, Subarna verfasserin aut Wong, Monica D. verfasserin aut Lam, Lydia verfasserin aut Benjamin, Elizabeth verfasserin aut Demetriades, Demetrios verfasserin aut Enthalten in American College of Surgeons ; ID: gnd/5696-0 Journal of the American College of Surgeons New York, NY : Elsevier, 1997 229, Seite 184-191 Online-Ressource (DE-627)320594459 (DE-600)2019367-1 (DE-576)118488945 1879-1190 nnns volume:229 pages:184-191 GBV_USEFLAG_U SYSFLAG_U GBV_ELV SSG-OLC-PHA GBV_ILN_31 GBV_ILN_2004 GBV_ILN_2011 GBV_ILN_2336 GBV_ILN_4305 44.65 Chirurgie AR 229 184-191 |
| allfields_unstemmed |
10.1016/j.jamcollsurg.2019.03.021 doi (DE-627)ELV002621665 (ELSEVIER)S1072-7515(19)30256-X DE-627 ger DE-627 rda eng 610 DE-600 44.65 bkl Priestley, Erika M. verfasserin aut Pulse Pressure as an Early Warning of Hemorrhage in Trauma Patients 2019 nicht spezifiziert zzz rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: Hypotension based on low systolic blood pressure (SBP) is a well-documented indicator of ongoing blood loss. However, the utility of pulse pressure (PP) for detection of hemorrhage has not been well studied. The purpose of this study was to determine whether a narrowed PP in nonhypotensive patients is an independent predictor of critical administration threshold (CAT+) hemorrhage requiring surgical or endovascular control.Study Design: We performed a retrospective single-center study (January 2010 to October 2014), including trauma patients ≥16 years old with SBP ≥ 90 mmHg upon emergency department (ED) admission. We identified patients who were both CAT+ and required either surgical or interventional radiology for definitive hemorrhage control as the active hemorrhage (AH) group. Analyses were then performed to elucidate the association between PP and hemorrhage.Results: Of the total 18,015 patients identified, 283 (1.6%) met the criteria for clinically significant hemorrhage. Mean PP was significantly lower in the AH group compared with the non-AH group (39 ± 18 mmHg vs 53 ± 19 mmHg, p < 0.0001). Multivariate analysis revealed that narrowed initial ED PP is an independent predictor of AH (adjusted odds ratio [AOR] 0.975) along with age (AOR 1.01), penetrating mechanism (AOR 9.476), field SBP (AOR 0.985), ED heart rate (AOR 1.024), and Injury Severity Score (AOR 1.126). Cutoff analysis of PP values identified a significantly higher risk of AH at a PP cutoff of 55 mmHg (AOR 3.44, p = 0.005, AUC 0.955) in patients 61 years or older vs 40 mmHg (AOR 2.73, p < 0.0001, AUC 0.940) for patients 16 to 60 years old. The predicted probability of AH increases as PP narrows.Conclusions: In patients who are nonhypotensive, a narrowed PP is an independent early predictor of active hemorrhage requiring blood product transfusion and intervention for hemorrhage control. Inaba, Kenji verfasserin aut Byerly, Saskya verfasserin aut Biswas, Subarna verfasserin aut Wong, Monica D. verfasserin aut Lam, Lydia verfasserin aut Benjamin, Elizabeth verfasserin aut Demetriades, Demetrios verfasserin aut Enthalten in American College of Surgeons ; ID: gnd/5696-0 Journal of the American College of Surgeons New York, NY : Elsevier, 1997 229, Seite 184-191 Online-Ressource (DE-627)320594459 (DE-600)2019367-1 (DE-576)118488945 1879-1190 nnns volume:229 pages:184-191 GBV_USEFLAG_U SYSFLAG_U GBV_ELV SSG-OLC-PHA GBV_ILN_31 GBV_ILN_2004 GBV_ILN_2011 GBV_ILN_2336 GBV_ILN_4305 44.65 Chirurgie AR 229 184-191 |
| allfieldsGer |
10.1016/j.jamcollsurg.2019.03.021 doi (DE-627)ELV002621665 (ELSEVIER)S1072-7515(19)30256-X DE-627 ger DE-627 rda eng 610 DE-600 44.65 bkl Priestley, Erika M. verfasserin aut Pulse Pressure as an Early Warning of Hemorrhage in Trauma Patients 2019 nicht spezifiziert zzz rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: Hypotension based on low systolic blood pressure (SBP) is a well-documented indicator of ongoing blood loss. However, the utility of pulse pressure (PP) for detection of hemorrhage has not been well studied. The purpose of this study was to determine whether a narrowed PP in nonhypotensive patients is an independent predictor of critical administration threshold (CAT+) hemorrhage requiring surgical or endovascular control.Study Design: We performed a retrospective single-center study (January 2010 to October 2014), including trauma patients ≥16 years old with SBP ≥ 90 mmHg upon emergency department (ED) admission. We identified patients who were both CAT+ and required either surgical or interventional radiology for definitive hemorrhage control as the active hemorrhage (AH) group. Analyses were then performed to elucidate the association between PP and hemorrhage.Results: Of the total 18,015 patients identified, 283 (1.6%) met the criteria for clinically significant hemorrhage. Mean PP was significantly lower in the AH group compared with the non-AH group (39 ± 18 mmHg vs 53 ± 19 mmHg, p < 0.0001). Multivariate analysis revealed that narrowed initial ED PP is an independent predictor of AH (adjusted odds ratio [AOR] 0.975) along with age (AOR 1.01), penetrating mechanism (AOR 9.476), field SBP (AOR 0.985), ED heart rate (AOR 1.024), and Injury Severity Score (AOR 1.126). Cutoff analysis of PP values identified a significantly higher risk of AH at a PP cutoff of 55 mmHg (AOR 3.44, p = 0.005, AUC 0.955) in patients 61 years or older vs 40 mmHg (AOR 2.73, p < 0.0001, AUC 0.940) for patients 16 to 60 years old. The predicted probability of AH increases as PP narrows.Conclusions: In patients who are nonhypotensive, a narrowed PP is an independent early predictor of active hemorrhage requiring blood product transfusion and intervention for hemorrhage control. Inaba, Kenji verfasserin aut Byerly, Saskya verfasserin aut Biswas, Subarna verfasserin aut Wong, Monica D. verfasserin aut Lam, Lydia verfasserin aut Benjamin, Elizabeth verfasserin aut Demetriades, Demetrios verfasserin aut Enthalten in American College of Surgeons ; ID: gnd/5696-0 Journal of the American College of Surgeons New York, NY : Elsevier, 1997 229, Seite 184-191 Online-Ressource (DE-627)320594459 (DE-600)2019367-1 (DE-576)118488945 1879-1190 nnns volume:229 pages:184-191 GBV_USEFLAG_U SYSFLAG_U GBV_ELV SSG-OLC-PHA GBV_ILN_31 GBV_ILN_2004 GBV_ILN_2011 GBV_ILN_2336 GBV_ILN_4305 44.65 Chirurgie AR 229 184-191 |
| allfieldsSound |
10.1016/j.jamcollsurg.2019.03.021 doi (DE-627)ELV002621665 (ELSEVIER)S1072-7515(19)30256-X DE-627 ger DE-627 rda eng 610 DE-600 44.65 bkl Priestley, Erika M. verfasserin aut Pulse Pressure as an Early Warning of Hemorrhage in Trauma Patients 2019 nicht spezifiziert zzz rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: Hypotension based on low systolic blood pressure (SBP) is a well-documented indicator of ongoing blood loss. However, the utility of pulse pressure (PP) for detection of hemorrhage has not been well studied. The purpose of this study was to determine whether a narrowed PP in nonhypotensive patients is an independent predictor of critical administration threshold (CAT+) hemorrhage requiring surgical or endovascular control.Study Design: We performed a retrospective single-center study (January 2010 to October 2014), including trauma patients ≥16 years old with SBP ≥ 90 mmHg upon emergency department (ED) admission. We identified patients who were both CAT+ and required either surgical or interventional radiology for definitive hemorrhage control as the active hemorrhage (AH) group. Analyses were then performed to elucidate the association between PP and hemorrhage.Results: Of the total 18,015 patients identified, 283 (1.6%) met the criteria for clinically significant hemorrhage. Mean PP was significantly lower in the AH group compared with the non-AH group (39 ± 18 mmHg vs 53 ± 19 mmHg, p < 0.0001). Multivariate analysis revealed that narrowed initial ED PP is an independent predictor of AH (adjusted odds ratio [AOR] 0.975) along with age (AOR 1.01), penetrating mechanism (AOR 9.476), field SBP (AOR 0.985), ED heart rate (AOR 1.024), and Injury Severity Score (AOR 1.126). Cutoff analysis of PP values identified a significantly higher risk of AH at a PP cutoff of 55 mmHg (AOR 3.44, p = 0.005, AUC 0.955) in patients 61 years or older vs 40 mmHg (AOR 2.73, p < 0.0001, AUC 0.940) for patients 16 to 60 years old. The predicted probability of AH increases as PP narrows.Conclusions: In patients who are nonhypotensive, a narrowed PP is an independent early predictor of active hemorrhage requiring blood product transfusion and intervention for hemorrhage control. Inaba, Kenji verfasserin aut Byerly, Saskya verfasserin aut Biswas, Subarna verfasserin aut Wong, Monica D. verfasserin aut Lam, Lydia verfasserin aut Benjamin, Elizabeth verfasserin aut Demetriades, Demetrios verfasserin aut Enthalten in American College of Surgeons ; ID: gnd/5696-0 Journal of the American College of Surgeons New York, NY : Elsevier, 1997 229, Seite 184-191 Online-Ressource (DE-627)320594459 (DE-600)2019367-1 (DE-576)118488945 1879-1190 nnns volume:229 pages:184-191 GBV_USEFLAG_U SYSFLAG_U GBV_ELV SSG-OLC-PHA GBV_ILN_31 GBV_ILN_2004 GBV_ILN_2011 GBV_ILN_2336 GBV_ILN_4305 44.65 Chirurgie AR 229 184-191 |
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Priestley, Erika M. @@aut@@ Inaba, Kenji @@aut@@ Byerly, Saskya @@aut@@ Biswas, Subarna @@aut@@ Wong, Monica D. @@aut@@ Lam, Lydia @@aut@@ Benjamin, Elizabeth @@aut@@ Demetriades, Demetrios @@aut@@ |
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<?xml version="1.0" encoding="UTF-8"?><collection xmlns="http://www.loc.gov/MARC21/slim"><record><leader>01000caa a22002652 4500</leader><controlfield tag="001">ELV002621665</controlfield><controlfield tag="003">DE-627</controlfield><controlfield tag="005">20230524150841.0</controlfield><controlfield tag="007">cr uuu---uuuuu</controlfield><controlfield tag="008">230429s2019 xx |||||o 00| ||eng c</controlfield><datafield tag="024" ind1="7" ind2=" "><subfield code="a">10.1016/j.jamcollsurg.2019.03.021</subfield><subfield code="2">doi</subfield></datafield><datafield tag="035" ind1=" " ind2=" "><subfield code="a">(DE-627)ELV002621665</subfield></datafield><datafield tag="035" ind1=" " ind2=" "><subfield code="a">(ELSEVIER)S1072-7515(19)30256-X</subfield></datafield><datafield tag="040" ind1=" " ind2=" "><subfield code="a">DE-627</subfield><subfield code="b">ger</subfield><subfield code="c">DE-627</subfield><subfield code="e">rda</subfield></datafield><datafield tag="041" ind1=" " ind2=" "><subfield code="a">eng</subfield></datafield><datafield tag="082" ind1="0" ind2="4"><subfield code="a">610</subfield><subfield code="q">DE-600</subfield></datafield><datafield tag="084" ind1=" " ind2=" "><subfield code="a">44.65</subfield><subfield code="2">bkl</subfield></datafield><datafield tag="100" ind1="1" ind2=" "><subfield code="a">Priestley, Erika M.</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="245" ind1="1" ind2="0"><subfield code="a">Pulse Pressure as an Early Warning of Hemorrhage in Trauma Patients</subfield></datafield><datafield tag="264" ind1=" " ind2="1"><subfield code="c">2019</subfield></datafield><datafield tag="336" ind1=" " ind2=" "><subfield code="a">nicht spezifiziert</subfield><subfield code="b">zzz</subfield><subfield code="2">rdacontent</subfield></datafield><datafield tag="337" ind1=" " ind2=" "><subfield code="a">Computermedien</subfield><subfield code="b">c</subfield><subfield code="2">rdamedia</subfield></datafield><datafield tag="338" ind1=" " ind2=" "><subfield code="a">Online-Ressource</subfield><subfield code="b">cr</subfield><subfield code="2">rdacarrier</subfield></datafield><datafield tag="520" ind1=" " ind2=" "><subfield code="a">Background: Hypotension based on low systolic blood pressure (SBP) is a well-documented indicator of ongoing blood loss. However, the utility of pulse pressure (PP) for detection of hemorrhage has not been well studied. The purpose of this study was to determine whether a narrowed PP in nonhypotensive patients is an independent predictor of critical administration threshold (CAT+) hemorrhage requiring surgical or endovascular control.Study Design: We performed a retrospective single-center study (January 2010 to October 2014), including trauma patients ≥16 years old with SBP ≥ 90 mmHg upon emergency department (ED) admission. We identified patients who were both CAT+ and required either surgical or interventional radiology for definitive hemorrhage control as the active hemorrhage (AH) group. Analyses were then performed to elucidate the association between PP and hemorrhage.Results: Of the total 18,015 patients identified, 283 (1.6%) met the criteria for clinically significant hemorrhage. Mean PP was significantly lower in the AH group compared with the non-AH group (39 ± 18 mmHg vs 53 ± 19 mmHg, p < 0.0001). Multivariate analysis revealed that narrowed initial ED PP is an independent predictor of AH (adjusted odds ratio [AOR] 0.975) along with age (AOR 1.01), penetrating mechanism (AOR 9.476), field SBP (AOR 0.985), ED heart rate (AOR 1.024), and Injury Severity Score (AOR 1.126). Cutoff analysis of PP values identified a significantly higher risk of AH at a PP cutoff of 55 mmHg (AOR 3.44, p = 0.005, AUC 0.955) in patients 61 years or older vs 40 mmHg (AOR 2.73, p < 0.0001, AUC 0.940) for patients 16 to 60 years old. The predicted probability of AH increases as PP narrows.Conclusions: In patients who are nonhypotensive, a narrowed PP is an independent early predictor of active hemorrhage requiring blood product transfusion and intervention for hemorrhage control.</subfield></datafield><datafield tag="700" ind1="1" ind2=" "><subfield code="a">Inaba, Kenji</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="1" ind2=" "><subfield code="a">Byerly, Saskya</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="1" ind2=" "><subfield code="a">Biswas, Subarna</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="1" ind2=" "><subfield code="a">Wong, Monica D.</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="1" ind2=" "><subfield code="a">Lam, Lydia</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="1" ind2=" "><subfield code="a">Benjamin, Elizabeth</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="1" ind2=" "><subfield code="a">Demetriades, Demetrios</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="773" ind1="0" ind2="8"><subfield code="i">Enthalten in</subfield><subfield code="a">American College of Surgeons ; ID: gnd/5696-0</subfield><subfield code="t">Journal of the American College of Surgeons</subfield><subfield code="d">New York, NY : Elsevier, 1997</subfield><subfield code="g">229, Seite 184-191</subfield><subfield code="h">Online-Ressource</subfield><subfield code="w">(DE-627)320594459</subfield><subfield code="w">(DE-600)2019367-1</subfield><subfield code="w">(DE-576)118488945</subfield><subfield code="x">1879-1190</subfield><subfield code="7">nnns</subfield></datafield><datafield tag="773" ind1="1" ind2="8"><subfield code="g">volume:229</subfield><subfield code="g">pages:184-191</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_USEFLAG_U</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">SYSFLAG_U</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ELV</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">SSG-OLC-PHA</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_31</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_2004</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_2011</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_2336</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_4305</subfield></datafield><datafield tag="936" ind1="b" ind2="k"><subfield code="a">44.65</subfield><subfield code="j">Chirurgie</subfield></datafield><datafield tag="951" ind1=" " ind2=" "><subfield code="a">AR</subfield></datafield><datafield tag="952" ind1=" " ind2=" "><subfield code="d">229</subfield><subfield code="h">184-191</subfield></datafield></record></collection>
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pulse pressure as an early warning of hemorrhage in trauma patients |
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Pulse Pressure as an Early Warning of Hemorrhage in Trauma Patients |
| abstract |
Background: Hypotension based on low systolic blood pressure (SBP) is a well-documented indicator of ongoing blood loss. However, the utility of pulse pressure (PP) for detection of hemorrhage has not been well studied. The purpose of this study was to determine whether a narrowed PP in nonhypotensive patients is an independent predictor of critical administration threshold (CAT+) hemorrhage requiring surgical or endovascular control.Study Design: We performed a retrospective single-center study (January 2010 to October 2014), including trauma patients ≥16 years old with SBP ≥ 90 mmHg upon emergency department (ED) admission. We identified patients who were both CAT+ and required either surgical or interventional radiology for definitive hemorrhage control as the active hemorrhage (AH) group. Analyses were then performed to elucidate the association between PP and hemorrhage.Results: Of the total 18,015 patients identified, 283 (1.6%) met the criteria for clinically significant hemorrhage. Mean PP was significantly lower in the AH group compared with the non-AH group (39 ± 18 mmHg vs 53 ± 19 mmHg, p < 0.0001). Multivariate analysis revealed that narrowed initial ED PP is an independent predictor of AH (adjusted odds ratio [AOR] 0.975) along with age (AOR 1.01), penetrating mechanism (AOR 9.476), field SBP (AOR 0.985), ED heart rate (AOR 1.024), and Injury Severity Score (AOR 1.126). Cutoff analysis of PP values identified a significantly higher risk of AH at a PP cutoff of 55 mmHg (AOR 3.44, p = 0.005, AUC 0.955) in patients 61 years or older vs 40 mmHg (AOR 2.73, p < 0.0001, AUC 0.940) for patients 16 to 60 years old. The predicted probability of AH increases as PP narrows.Conclusions: In patients who are nonhypotensive, a narrowed PP is an independent early predictor of active hemorrhage requiring blood product transfusion and intervention for hemorrhage control. |
| abstractGer |
Background: Hypotension based on low systolic blood pressure (SBP) is a well-documented indicator of ongoing blood loss. However, the utility of pulse pressure (PP) for detection of hemorrhage has not been well studied. The purpose of this study was to determine whether a narrowed PP in nonhypotensive patients is an independent predictor of critical administration threshold (CAT+) hemorrhage requiring surgical or endovascular control.Study Design: We performed a retrospective single-center study (January 2010 to October 2014), including trauma patients ≥16 years old with SBP ≥ 90 mmHg upon emergency department (ED) admission. We identified patients who were both CAT+ and required either surgical or interventional radiology for definitive hemorrhage control as the active hemorrhage (AH) group. Analyses were then performed to elucidate the association between PP and hemorrhage.Results: Of the total 18,015 patients identified, 283 (1.6%) met the criteria for clinically significant hemorrhage. Mean PP was significantly lower in the AH group compared with the non-AH group (39 ± 18 mmHg vs 53 ± 19 mmHg, p < 0.0001). Multivariate analysis revealed that narrowed initial ED PP is an independent predictor of AH (adjusted odds ratio [AOR] 0.975) along with age (AOR 1.01), penetrating mechanism (AOR 9.476), field SBP (AOR 0.985), ED heart rate (AOR 1.024), and Injury Severity Score (AOR 1.126). Cutoff analysis of PP values identified a significantly higher risk of AH at a PP cutoff of 55 mmHg (AOR 3.44, p = 0.005, AUC 0.955) in patients 61 years or older vs 40 mmHg (AOR 2.73, p < 0.0001, AUC 0.940) for patients 16 to 60 years old. The predicted probability of AH increases as PP narrows.Conclusions: In patients who are nonhypotensive, a narrowed PP is an independent early predictor of active hemorrhage requiring blood product transfusion and intervention for hemorrhage control. |
| abstract_unstemmed |
Background: Hypotension based on low systolic blood pressure (SBP) is a well-documented indicator of ongoing blood loss. However, the utility of pulse pressure (PP) for detection of hemorrhage has not been well studied. The purpose of this study was to determine whether a narrowed PP in nonhypotensive patients is an independent predictor of critical administration threshold (CAT+) hemorrhage requiring surgical or endovascular control.Study Design: We performed a retrospective single-center study (January 2010 to October 2014), including trauma patients ≥16 years old with SBP ≥ 90 mmHg upon emergency department (ED) admission. We identified patients who were both CAT+ and required either surgical or interventional radiology for definitive hemorrhage control as the active hemorrhage (AH) group. Analyses were then performed to elucidate the association between PP and hemorrhage.Results: Of the total 18,015 patients identified, 283 (1.6%) met the criteria for clinically significant hemorrhage. Mean PP was significantly lower in the AH group compared with the non-AH group (39 ± 18 mmHg vs 53 ± 19 mmHg, p < 0.0001). Multivariate analysis revealed that narrowed initial ED PP is an independent predictor of AH (adjusted odds ratio [AOR] 0.975) along with age (AOR 1.01), penetrating mechanism (AOR 9.476), field SBP (AOR 0.985), ED heart rate (AOR 1.024), and Injury Severity Score (AOR 1.126). Cutoff analysis of PP values identified a significantly higher risk of AH at a PP cutoff of 55 mmHg (AOR 3.44, p = 0.005, AUC 0.955) in patients 61 years or older vs 40 mmHg (AOR 2.73, p < 0.0001, AUC 0.940) for patients 16 to 60 years old. The predicted probability of AH increases as PP narrows.Conclusions: In patients who are nonhypotensive, a narrowed PP is an independent early predictor of active hemorrhage requiring blood product transfusion and intervention for hemorrhage control. |
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Pulse Pressure as an Early Warning of Hemorrhage in Trauma Patients |
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