Prehospital heart rate and blood pressure increase the positive predictive value of the Glasgow Coma Scale for high-mortality traumatic brain injury.
No Thumbnail Available
Date
2014-05-08
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
We hypothesized that vital signs could be used to improve the association between a trauma patient s prehospital Glasgow Coma Scale GCS score and his or her clinical condition Previously abnormally low and high blood pressures have both been associated with higher mortality for patients with traumatic brain injury TBI We undertook a retrospective analysis of 1384 adult prehospital trauma patients Vital sign data were electronically archived and analyzed We examined the relative risk of severe head Abbreviated Injury Scale AIS 5 6 as a function of the GCS systolic blood pressure SBP heart rate HR and respiratory rate RR We created multi variate logistic regression models and using DeLong s test compared their area under receiver operating characteristic curves ROC AUCs for three outcomes head AIS 5 6 all cause mortality and either head AIS 5 6 or neurosurgical procedure We found significant bimodal relationships between head AIS 5 6 versus SBP and HR but not RR When the GCS was Under15 ROC AUCs were significantly higher for a multi variate regression model GCS SBP and HR versus GCS alone In particular patients with abnormalities in all parameters GCS SBP and HR were significantly more likely to have high mortality TBI versus those with abnormalities in GCS alone This could be useful for mobilizing resources e g neurosurgeons and operating rooms at the receiving hospital and might enable new prehospital management protocols where therapies are selected based on TBI mortality risk