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Early Vital Sign Thresholds Associated with 24-Hour Mortality among Trauma Patients: A Trauma Quality Improvement Program (TQIP) Study

Published online by Cambridge University Press:  02 April 2024

Michael D. April Open the ORCID record for Michael D. April [Opens in a new window] ,
Andrew D. Fisher ,
Julie A. Rizzo ,
Franklin L. Wright ,
Julie M. Winkle  and
Steven G. Schauer Open the ORCID record for Steven G. Schauer [Opens in a new window]
Michael D. April*
Affiliation:
Uniformed Services University of the Health Sciences, Bethesda, Maryland USA 14th Field Hospital, Fort Stewart, Georgia USA
Andrew D. Fisher
Affiliation:
Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico USA
Julie A. Rizzo
Affiliation:
Uniformed Services University of the Health Sciences, Bethesda, Maryland USA Brooke Army Medical Center, JBSA Fort Sam Houston, Texas USA
Franklin L. Wright
Affiliation:
University of Colorado School of Medicine, Department of Surgery, Aurora, Colorado USA
Julie M. Winkle
Affiliation:
University of Colorado School of Medicine, Departments of Anesthesia and Emergency Medicine, Aurora, Colorado USA
Steven G. Schauer
Affiliation:
Uniformed Services University of the Health Sciences, Bethesda, Maryland USA University of Colorado School of Medicine, Departments of Anesthesia and Emergency Medicine, Aurora, Colorado USA University of Colorado School of Medicine Center for Combat and Battlefield (COMBAT) Research, Aurora, Colorado USA
*
Correspondence: Dr. Michael D. April Building 816A 2233 Gulick Ave Fort Stewart, Georgia 31314 USA E-mail: Michael.d.april@post.harvard.edu
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Abstract

Background:

Identifying patients at imminent risk of death is critical in the management of trauma patients. This study measures the vital sign thresholds associated with death among trauma patients.

Methods:

This study included data from patients ≥15 years of age in the American College of Surgeons Trauma Quality Improvement Program (TQIP) database. Patients with vital signs of zero were excluded. Documented prehospital and emergency department (ED) vital signs included systolic pressure, heart rate, respiratory rate, and calculated shock index (SI). The area under the receiver operator curves (AUROC) was used to assess the accuracy of these variables for predicting 24-hour survival. Optimal thresholds to predict mortality were identified using Youden’s Index, 90% specificity, and 90% sensitivity. Additional analyses examined patients 70+ years of age.

Results:

There were 1,439,221 subjects in the 2019-2020 datasets that met inclusion for this analysis with <0.1% (10,270) who died within 24 hours. The optimal threshold for prehospital systolic pressure was 110, pulse rate was 110, SI was 0.9, and respiratory rate was 15. The optimal threshold for the ED systolic was 112, pulse rate was 107, SI was 0.9, and respiratory rate was 21. Among the elderly sub-analysis, the optimal threshold for prehospital systolic was 116, pulse rate was 100, SI was 0.8, and respiratory rate was 21. The optimal threshold for ED systolic was 121, pulse rate was 95, SI was 0.8, and respiratory rate was 21.

Conclusions:

Systolic blood pressure (SBP) and SI offered the best predictor of mortality among trauma patients. The SBP values predictive of mortality were significantly higher than the traditional 90mmHg threshold. This dataset highlights the need for better methods to guide resuscitation as initial vital signs have limited accuracy in predicting subsequent mortality.

Keywords

hemorrhagehypotensionshocktraumavital signs

Information

Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 39 , Issue 2 , April 2024 , pp. 151 - 155
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Creative Commons
This is a work of the US Government and is not subject to copyright protection within the United States. Published by Cambridge University Press on behalf of World Association for Disaster and Emergency Medicine.
Copyright
© US Department of Defense, 2024

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