Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Sep 9, 2025; 14(3): 104778
Published online Sep 9, 2025. doi: 10.5492/wjccm.v14.i3.104778
Significance of a hypotensive episode following traumatic injury: A retrospective observational study
Hassan Al-Thani, Ayman El-Menyar, Ahammed Mekkodathil, Ibrahim Taha, Saeed Mahmood, Adam Shunni, Abdel Aziz Hammo, Mushreq Al-Ani, Mohammad Asim
Hassan Al-Thani, Ayman El-Menyar, Ahammed Mekkodathil, Ibrahim Taha, Saeed Mahmood, Adam Shunni, Abdel Aziz Hammo, Mushreq Al-Ani, Mohammad Asim, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
Ayman El-Menyar, Department of Clinical Medicine, Weill Cornell Medicine, Doha 24144, Qatar
Author contributions: All authors contributed to the study design, data analysis and interpretation, and manuscript writing and approved the final manuscript; Asim M and Mekkodathil A analyzed the data, and El-Menyar A supervised and edited the manuscript.
Institutional review board statement: Ethical approval was obtained from the institutional review board (MRC-01-21-990) at the Medical Research Center, Hamad Medical Corporation (HMC), Doha, Qatar. Data was collected retrospectively and anonymously with no direct contact with the patients; therefore, a waiver of consent was granted.
Informed consent statement: A statement of informed consent was not required for this study.
Conflict-of-interest statement: Dr. El-Menyar has nothing to disclose.
Data sharing statement: All data are presented in the manuscript. After a reasonable research request and signed data share agreement, further access needs approval from the medical research center at Hamad Medical Corporation.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ayman El-Menyar, Professor, Department of Surgery, Hamad Medical Corporation, Al-Rayyan Street, Doha 3050, Qatar. aymanco65@yahoo.com
Received: January 2, 2025
Revised: March 24, 2025
Accepted: May 7, 2025
Published online: September 9, 2025
Processing time: 199 Days and 5.1 Hours
Abstract
BACKGROUND

Early hemodynamic assessment remains crucial for proper management in trauma settings. Hypotension is a vital indication in trauma patients to be considered upon initial triaging to assess the risk of bleeding and hypovolemic shock which entails significant clinical attention during initial resuscitation.

AIM

To assess whether an initial episode of prehospital or emergency department hypotension is associated with an increased risk of morbidity and mortality in trauma patients.

METHODS

A retrospective analysis was performed to include all trauma patients hospitalized between 2011 and 2021. Hypotension was defined as a systolic blood pressure ≤ 90 mmHg in the prehospital setting or upon arrival to the hospital. Patients were classified into normotensive vs hypotensive and survivors vs non-survivors. Data was analyzed and compared, and multivariable logistic regression analysis was performed to identify the predictors of mortality.

RESULTS

Over the ten years, 17341 trauma admissions were analyzed, of which 1188 (6.9%) patients had hypotension episodes either at the scene or upon hospital arrival. Patients with hypotension were two years younger (P = 0.001) in age and were more likely to have higher pulse rate (P = 0.001), elevated shock index (P = 0.001), sustained more severe injuries, frequently required blood transfusion and laparotomy, and had higher complications and mortality rates. Multivariable regression analysis identified hypotension [adjusted odds ratio (aOR) = 2.505; 95% confidence interval (95%CI) = 1.798-3.489; P = 0.001] and acute respiratory distress syndrome (ARDS; aOR = 5.482; 95%CI = 3.297-9.116; P = 0.001) as independent predictors of mortality. Among hypotensive trauma patients, only ARDS (aOR = 3.518; 95%CI = 1.385-7.204; P = 0.006) was significantly associated with mortality.

CONCLUSION

Hypotensive episodes following trauma are associated with higher severity and mortality. The development of ARDS is an independent predictor of mortality in hypotensive trauma patients. A hypotensive episode is a warning sign and calls for aggressive, timely management following trauma.

Keywords: Hypotension; Prehospital; Injury; Trauma; Bleeding; Predictors; Shock; Mortality

Core Tip: Hypotension has been linked to an increased risk of mortality in trauma patients. Therefore, early diagnosis of the cause of bleeding and shock is crucial for hemodynamic optimization. There is a strong correlation between the need for surgery and a single episode of hypotension recorded during initial resuscitation. Shock or hypotension is an important sign of physiological deterioration that poses a significant risk of morbidity and mortality among young trauma patients. Acute respiratory distress syndrome is an independent predictor of mortality in hypotensive trauma patients. Hence, it is essential to consider a single episode of acute hypotension during triage, as this may prove physiologically detrimental with impaired organ perfusion and the worst outcome in trauma patients. Therefore, patients with a tendency to experience hypotensive episodes should be closely monitored.