Daniel W. Spaite, MD, Chengcheng Hu, PhD, Bentley J

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Presentation transcript:

Association of Out-of-Hospital Hypotension Depth and Duration With Traumatic Brain Injury Mortality Daniel W. Spaite, MD, Chengcheng Hu, PhD, Bentley J. Bobrow, MD, Vatsal Chikani, MPH, Bruce Barnhart, RN, CEP, Joshua B. Gaither, MD, Kurt R. Denninghoff, MD, P. David Adelson, MD, Samuel M. Keim, MD, MS, Chad Viscusi, MD, Terry Mullins, MBA, Amber D. Rice, MD, MS, Duane Sherrill, PhD Annals of Emergency Medicine Volume 70, Issue 4, Pages 522-530.e1 (October 2017) DOI: 10.1016/j.annemergmed.2017.03.027 Copyright © 2017 American College of Emergency Physicians Terms and Conditions

Figure 1 Depth-duration dose plot from a study patient. Depth-duration dose=total area of the shaded region under 90 mm Hg. When the dose is calculated, if either the first (as in this case) or last recorded SBP is a hypotensive value, the shaded region is closed by a vertical line passing through this point. Annals of Emergency Medicine 2017 70, 522-530.e1DOI: (10.1016/j.annemergmed.2017.03.027) Copyright © 2017 American College of Emergency Physicians Terms and Conditions

Figure 2 Depth-duration dose plot from a study patient with multiple hypotensive episodes. Depth-duration dose=total area of the shaded region under 90 mm Hg. When the dose is calculated, if either the first or last (as in this case) recorded SBP is a hypotensive value, the shaded region is closed by a vertical line passing through this point. This case shows a patient with 3 separate hypotensive episodes in which the total dose is the sum of the AUC from all of the shaded regions. Annals of Emergency Medicine 2017 70, 522-530.e1DOI: (10.1016/j.annemergmed.2017.03.027) Copyright © 2017 American College of Emergency Physicians Terms and Conditions

Figure 3 Case inclusion/exclusion flow chart. SBP, Systolic blood pressure; ISS, Injury Severity Score. Annals of Emergency Medicine 2017 70, 522-530.e1DOI: (10.1016/j.annemergmed.2017.03.027) Copyright © 2017 American College of Emergency Physicians Terms and Conditions

Figure 4 Distribution of hypotension depth, duration, and dose across the hypotensive cohort. Histograms show the proportions of hypotensive patients by depth, duration, and dose of hypotension. Annals of Emergency Medicine 2017 70, 522-530.e1DOI: (10.1016/j.annemergmed.2017.03.027) Copyright © 2017 American College of Emergency Physicians Terms and Conditions

Figure 5 Unadjusted death proportion by hypotension dose categories. Error bars represent 95% CIs. Hypotension was defined as systolic blood pressure less than 90 mm Hg. Annals of Emergency Medicine 2017 70, 522-530.e1DOI: (10.1016/j.annemergmed.2017.03.027) Copyright © 2017 American College of Emergency Physicians Terms and Conditions

Figure 6 Relationship of hypotension depth-duration dose to adjusted probability of death. Dotted lines represent pointwise 95% confidence band. Hypotension was defined as systolic blood pressure less than 90 mm Hg. x axis is log2 scale. Annals of Emergency Medicine 2017 70, 522-530.e1DOI: (10.1016/j.annemergmed.2017.03.027) Copyright © 2017 American College of Emergency Physicians Terms and Conditions