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首页> 外文期刊>International Journal of Environmental Research and Public Health >Systolic Blood Pressure Lower than Heart Rate upon Arrival at and Departure from the Emergency Department Indicates a Poor Outcome for Adult Trauma Patients
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Systolic Blood Pressure Lower than Heart Rate upon Arrival at and Departure from the Emergency Department Indicates a Poor Outcome for Adult Trauma Patients

机译：急诊室到达和离开急诊室时收缩压低于心率，表明成年创伤患者的预后差

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Background: Hemorrhage is a leading cause of preventable trauma death. In this study, we used the reverse shock index (RSI), a ratio of systolic blood pressure (SBP) to heart rate (HR), to evaluate the hemodynamic stability of trauma patients. As an SBP lower than the HR (RSI < 1) may indicate hemodynamic instability, the objective of this study was to assess the associated complications in trauma patients with an RSI < 1 upon arrival at the emergency department (ED) (indicated as (A)RSI) and at the time of departure from the ED (indicated as (L)RSI) to the operative room or for admission. Methods: Data obtained from all 16,548 hospitalized patients recorded in the trauma registry system at a Level I trauma center between January 2009 and December 2013 were retrospectively reviewed. A total of 10,234 adult trauma patients aged ≥20 were enrolled and subsequently divided into four groups: Group I, (A)RSI ≥ 1 and (L)RSI ≥ 1 ( n = 9827); Group II, (A)RSI ≥ 1 and (L)RSI < 1 ( n = 76); Group III, (A)RSI < 1 and (L)RSI ≥ 1 ( n = 251); and Group IV, (A)RSI < 1 and (L)RSI < 1 ( n = 80). Pearson’s χ 2 test, Fisher’s exact test, or independent Student’s t -test was conducted to compare trauma patients in Groups II, III, and IV with those in Group I. Results: Patients in Groups II, III, and IV had a higher injury severity score and underwent a higher number of procedures, including intubation, chest tube insertion, and blood transfusion, than Group I patients. Additionally, patients of these groups had increased hospital length of stay (16.3 days, 14.9 days, and 22.0 days, respectively), proportion of patients admitted to the intensive care unit (ICU) (48.7%, 43.0%, and 62.5%, respectively), and in-hospital mortality (19.7%, 7.6%, and 27.5%, respectively). Although the trauma patients who had a SBP < 90 mmHg either upon arrival at or departure from the ED also present a more severe injury and poor outcome, those patients who had a SBP ≥ 90 mmHg but an RSI < 1 had a more severe injury and poor outcome than those patients who had a SBP ≥ 90 mmHg and an RSI ≥ 1. Conclusions: SBP lower than heart rate (RSI < 1) either upon arrival at or departure from the ED may indicate a detrimental sign of poor outcome in adult trauma patients even in the absence of noted hypotension.
机译：背景：出血是可预防的创伤死亡的主要原因。在这项研究中，我们使用了反向休克指数（RSI），即收缩压（SBP）与心率（HR）的比率来评估创伤患者的血液动力学稳定性。由于SBP低于HR（RSI <1）可能表明血流动力学不稳定，因此本研究的目的是评估到达急诊室（ED）后RSI <1的创伤患者的相关并发症（表示为（A ）RSI）以及从急诊室（指示为（L）RSI）离开手术室或进入手术室的时间。方法：回顾性分析2009年1月至2013年12月在一级创伤中心创伤登记系统中记录的所有16,548名住院患者的数据。共有10,234名年龄≥20的成年外伤患者入组，随后分为四组：I组，（A）RSI≥1和（L）RSI≥1（n = 9827）。第二组，（A）RSI≥1和（L）RSI <1（n = 76）;第三组，（A）RSI <1和（L）RSI≥1（n = 251）;和第IV组，（A）RSI <1和（L）RSI <1（n = 80）。进行了Pearsonχ2检验，Fisher精确检验或独立的Student t检验，以比较II，III和IV组与I组的创伤患者。结果：II，III和IV组的患者受伤程度更高严重程度评分较高，并且进行了比I组患者更多的操作，包括插管，胸管插入和输血。此外，这些组的患者住院天数增加（分别为16.3天，14.9天和22.0天），重症监护病房（ICU）的住院患者比例（分别为48.7％，43.0％和62.5％） ）和医院内死亡率（分别为19.7％，7.6％和27.5％）。尽管到达或离开ED时SBP <90 mmHg的创伤患者也表现出更严重的伤害和较差的预后，但SBP≥90 mmHg但RSI <1的那些患者则受到更严重的伤害，并且与SBP≥90 mmHg和RSI≥1的患者相比，预后较差。结论：到达或离开ED时，SBP低于心率（RSI <1）可能表明成人创伤预后不良患者即使没有明显的低血压。

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