Significance of a hypotensive episode following traumatic injury: A retrospective observational study

doi:10.5492/wjccm.v14.i3.104778

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 14, Issue 3

This Article

Academic Content and Language Evaluation of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (26)

All Articles published online

The chart showing PDF series, HTML series, Figures (1-1) series, Tables (1-5) series.

Item

Count

PDF

HTML

Figures (1-1)

Tables (1-5)

Sum=26

Publishing Process of This Article

The chart showing Browse series, Download series.

Item

Count

Browse

Download

Sum=0

Sep 9, 2025 (publication date) through Jul 18, 2025

Times Cited of This Article

Times Cited (0)

Journal Information of This Article

Publication Name

World Journal of Critical Care Medicine

ISSN

2220-3141

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Crit Care Med. Sep 9, 2025; 14(3): 104778
Published online Sep 9, 2025. doi: 10.5492/wjccm.v14.i3.104778

Table 1 Demographics and clinical characteristics of trauma patients based on hemodynamic status (January 01, 2011 to April 30, 2021)

	Overall (n = 17341)	Normotensive (n = 16153)	Hypotensive (n = 1188)	P value
Age	32.3 ± 15.6	32.4 ± 15.6	30.5 ± 15.9	0.001
Males	15596 (89.9)	14559 (90.1)	1037 (87.3)	0.002
Vital signs at scene
Pulse rate	92.8 ± 21.2	92.3 ± 20.5	99.1 ± 27.9	0.001
SBP	130.8 ± 23.2	132.6 ± 21.4	106.3 ± 30.9	0.001
DBP	81.7 ± 18.4	82.6 ± 17.3	69.9 ± 26.3	0.001
GCS	15 (3-15)	15 (3-15)	14 (3-15)	0.001
Shock index	0.73 ± 0.23	0.71 ± 0.19	1.00 ± 0.43	0.001
Vital signs at ED
Pulse rate	91.6 ± 20.5	90.5 ± 19.5	107.3 ± 27.5	0.001
SBP	126.7 ± 20.9	128.9 ± 18.6	91.4 ± 22.2	0.001
DBP	77.1 ± 14.7	78.3 ± 13.6	57.7 ± 16.9	0.001
GCS	15 (3-15)	15 (3-15)	14 (3-15)	0.001
Shock index (n = 16622)	0.75 ± 0.26	0.72 ± 0.19	1.25 ± 0.52	0.001
Injury severity score	12.4 ± 9.5	11.7 ± 8.9	21.8 ± 13.6	0.001
Head AIS	3.4 ± 0.9	3.3 ± 0.9	3.9 ± 1.0	0.001
Chest AIS	2.7 ± 0.7	2.6 ± 0.7	3.0 ± 0.8	0.001
Abdomen AIS	2.5 ± 0.9	2.4 ± 0.8	2.9 ± 1.0	0.001
Intubation	3199 (18.4)	2461 (15.2)	738 (62.1)	0.001
Exploratory laparotomy	892 (5.1)	628 (3.9)	264 (22.2)	0.001
Blood transfusion	3052 (17.6)	2259 (14.0)	793 (66.8)	0.001
Blood units transfused	4 (1-79)	3 (1-79)	7 (1-73)	0.001
MTP activation	635 (3.6)	254 (1.6)	381 (32.1)	0.001
VAP	645 (3.7)	521 (3.2)	124 (10.4)	0.001
Sepsis	269 (1.6)	212 (1.3)	57 (4.8)	0.001
ARDS	135 (0.8)	86 (0.5)	49 (4.1)	0.001
Ventilator days	4 (1-180)	4 (1-180)	4 (1-115)	0.52
ICU LOS	4 (1-161)	4 (1-161)	5 (1-115)	0.001
Hospital LOS	5 (1-505)	5 (1-505)	8 (1-360)	0.001
Mortality	649 (3.7)	323 (2.0)	326 (27.4)	0.001

Data were presented as n (%), mean ± SD, or medians (range) whenever appropriate. Hypotension is defined as systolic blood pressure < 90 mmHg at prehospital/trauma room. SBP: Systolic blood pressure; DBP: Diastolic blood pressure; ED: Emergency department; GCS: Glasgow Coma score; VAP: Ventilator-associated pneumonia; AIS: Abbreviated injury score; MTP: Massive transfusion protocol; ARDS: Acute respiratory distress syndrome; ICU: Intensive care unit; LOS: length of stay.

Table 2 Overall demographics, clinical characteristics, management, and complications based on outcome (n = 17341)

	Survivors (n = 16692)	Non-survivors (n = 649)	P value
Age	32.1 ± 15.5	37.0 ± 17.9	0.001
Males	14993 (89.8)	603 (92.9)	0.01
Scene shock index	0.73 ± 0.22	0.81 ± 0.41	0.001
ED shock index	0.74 ± 0.23	1.09 ± 0.54	0.001
Hypotension	862 (5.2)	326 (50.2)	0.001
Injury severity score	11.7 ± 8.5	31.6 ± 12.5	0.001
GCS at ED	15 (3-15)	3 (3-15)	0.001
Head AIS	3.3 ± 0.9	4.5 ± 0.8	0.001
Chest AIS	2.6 ± 0.7	3.0 ± 0.8	0.001
Abdomen AIS	2.5 ± 0.9	2.9 ± 1.1	0.001
Intubation	2562 (15.3)	637 (98.2)	0.001
Exploratory laparotomy	753 (4.5)	139 (21.4)	0.001
Craniotomy/craniectomy	477 (2.9)	64 (9.9)	0.001
ORIF	3137 (18.8)	10 (1.5)	0.001
Blood transfusion	2546 (15.3)	506 (78.0)	0.001
Blood units transfused	3 (1-56)	8 (1-79)	0.001
MTP activation	382 (2.3)	253 (39.0)	0.001
Complications
ARDS	78 (0.5)	57 (8.8)	0.001
VAP	574 (3.4)	71 (10.9)	0.001
Sepsis	222 (1.3)	47 (7.2)	0.001
ICU LOS	4 (1-161)	5 (1-144)	0.04
Ventilator days	4 (1-180)	4 (1-144)	0.52

Data were presented as n (%), mean ± SD, or medians (range) whenever appropriate. ED: Emergency department; GCS: Glasgow Coma score; AIS: Abbreviated injury score; ORIF: Open reduction and internal fixation; MTP: Massive transfusion protocol; ARDS: Acute respiratory distress syndrome; VAP: Ventilator-associated pneumonia; ICU: Intensive care unit; LOS: length of stay.

Table 3 Comparison of demographics, clinical characteristics, management, and complications in hypotensive patients (n = 1188)

	Survivors (n = 862)	Non-survivors (n = 326)	P value
Age	29.5 ± 15.5	33.9 ± 16.6	0.001
Males	738 (85.6)	299 (91.7)	0.005
Associated injuries
Head	240 (27.8)	225 (69.0)	0.001
Chest	415 (48.1)	223 (68.4)	0.001
Abdomen	368 (42.7)	160 (49.1)	0.04
Pelvis	242 (28.1)	84 (25.8)	0.42
Shock index at scene	1.01 ± 0.41	0.97 ± 0.47	0.32
Shock index at ED	1.20 ± 0.49	1.49 ± 0.58	0.001
Injury severity score	17.9 ± 11.7	31.9 ± 12.9	0.001
GCS at ED	15 (3-15)	3 (3-15)	0.001
Head AIS	3.3 ± 0.9	4.4 ± 0.8	0.001
Chest AIS	2.9 ± 0.7	3.1 ± 0.8	0.001
Abdomen AIS	2.8 ± 1.0	3.0 ± 1.1	0.02
Intubation	415 (48.1)	323 (99.1)	0.001
Exploratory laparotomy	166 (19.3)	98 (30.1)	0.001
Craniotomy/craniectomy	29 (3.4)	11 (3.4)	0.99
ORIF	225 (26.1)	3 (0.9)	0.001
Blood transfusion	506 (58.7)	287 (88.0)	0.001
Blood units transfused	6 (1-56)	8 (1-73)	0.001
MTP activation	197 (22.9)	184 (56.4)	0.001
Complications
ARDS	25 (2.9)	24 (7.4)	0.001
VAP	100 (11.6)	24 (7.4)	0.03
Sepsis	35 (4.1)	22 (6.7)	0.05
ICU LOS	7 (1-112)	3 (1-115)	0.001
Ventilator days	6 (1-97)	2 (1-115)	0.001
Hospital length of stay	14 (1-360)	2 (1-115)	0.001

Table 4 Systolic blood pressure threshold and odds ratio of mortality in trauma patients, odd ratio (95% confidence interval)

SBP threshold (mmHg)	Prehospital	Emergency department
< 60 vs ≥ 60	9.324 (3.374-25.769)	23.303 (11.701-46.408)
< 70 vs ≥ 70	9.063 (4.930-16.662)	23.785 (15.754-35.910)
< 80 vs ≥ 80	6.994 (4.642-10.537)	19.937 (14.936-26.612)
< 90 vs ≥ 90	4.835 (3.540-6.604)	14.736 (11.775-18.443)
< 100 vs ≥ 100	3.341 (2.608-4.281)	9.157 (7.546-11.112)
< 110 vs ≥ 110	2.363 (1.913-2.919)	4.616 (3.852-5.531)
< 120 vs ≥ 120	1.541 (1.270-1.869)	2.568 (2.146-3.073)
< 130 vs ≥ 130	1.079 (0.894-1.303)	1.423 (1.174-1.726)

SBP: Systolic blood pressure.

Table 5 Multivariate regression analysis for the predictors of mortality

Variable	aOR	95%CI	P value
Model-I (for all trauma patients)
Age¹	1.043	1.034-1.051	0.001
Sex (male)	1.295	0.796-2.105	0.297
Hypotension	2.505	1.798-3.489	0.001
Shock index at ED¹	1.067	0.754-1.509	0.715
Injury severity score¹	1.093	1.080-1.105	0.001
GCS ED¹	0.802	0.782-0.823	0.001
Blood transfusion	2.218	1.665-2.955	0.001
Sepsis	0.709	0.449-1.119	0.140
ARDS	5.482	3.297-9.116	0.001
Model-II (for hypotensive trauma patients)
Age¹	1.024	1.008-1.039	0.002
Sex (male)	1.689	0.743-3.837	0.211
Shock index at ED¹	1.449	0.952-2.204	0.083
Injury severity score¹	1.078	1.055-1.102	0.001
GCS ED¹	0.802	0.766-0.841	0.001
Blood transfusion	0.985	0.512-1.897	0.964
Sepsis	1.384	0.635-3.016	0.414
ARDS	3.158	1.385-7.204	0.006

¹Continuous variable.

ED: Emergency department; GCS: Glasgow Coma score; ARDS: Acute respiratory distress syndrome; aOR: Adjusted odd ratio; 95%CI: 95% confidence interval.

Citation: Al-Thani H, El-Menyar A, Mekkodathil A, Taha I, Mahmood S, Shunni A, Hammo AA, Al-Ani M, Asim M. Significance of a hypotensive episode following traumatic injury: A retrospective observational study. World J Crit Care Med 2025; 14(3): 104778
URL: https://www.wjgnet.com/2220-3141/full/v14/i3/104778.htm
DOI: https://dx.doi.org/10.5492/wjccm.v14.i3.104778