Prehospital Heart Rate and Blood Pressure Increase the Positive Predictive Value of the Glasgow Coma Scale for High-Mortality Traumatic Brain Injury

摘要

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.