Prehospital hypotension as a valid indicator of trauma team activation

Background: Criteria for trauma team activation are continually being evalu ated to ensure proper utilization of resources. We examined the impact of p rehospital (PH) hypotension (systolic blood pressure less than or equal to 90) on outcome (operative intervention and mortality) and its usefulness as an indicator for trauma team activation, Methods: A database was created by using the trauma registry for all nonbur ned, injured patients from July of 1993 through October of 1998 at our Leve l I trauma center. Results: Of 6,976 patients (83% blunt injury) in the database, 4,437 had a PH blood pressure recorded. Documented PH hypotension was present in 791 pa tients. Hypotension persisted in the emergency department (ED) in 299 patie nts, but 193 of them showed minimal or no signs of life on arrival. Four hu ndred ninety-two patients had PH hypotension but normal ED systolic blood p ressure, and 130 patients developed ED hypotension after normal PN systolic blood pressure. Nearly half of the patients with hypotension were taken fr om the ED directly to the operating room primarily for hemorrhage control p rocedures. The early and late mortality rates of patients with PH and ED hy potension were 12% and 32%, respectively. Other PH interventions had minima l effect on mortality in the hypotensive patient. Conclusion: Prehospital hypotension remains a valid indicator for trauma te am activation. Even though most of the non-DOA patients (492 of 598) were s table on arrival to the ED, nearly 50% required operative intervention, and an additional 15% required intensive care unit admission. The trauma team should be activated and involved with these patients early.