Presenting blood pressure in traumatic brain injury: A bimodal distribution of death

Syed Nabeel Zafar, Frederick H. Millham, Yuchiao Chang, Karim Fikry, Hasan B. Alam, David R. King, George C. Velmahos, Marc A. De Moya*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

30 Scopus citations


Background: Recent research explores the relationship between vital signs on arrival to the emergency department and early outcomes. This work has not included traumatic brain injury (TBI). We aimed to evaluate the relationship of the initial emergency department systolic blood pressure (EDSBP) with outcome. Methods: By using the National Trauma Data Bank (v7), we analyzed patients older than 16 years with isolated moderate to severe blunt TBI. TBI was defined by International Classification of Diseases-9th Rev diagnosis codes and Abbreviated Injury Scale scores. We determined mortality rates while controlling for age, gender, race, payment type, and injury severity using logistic regression. Survival analysis was performed to determine 3-day survival rates. Scores and rates were plotted against EDSBP. Results: A total of 7,238 patients were included in the analysis. Plots of adverse outcomes versus EDSBP demonstrated bimodal distributions. The mortality curve had one inflection point at EDSBP 120 mm Hg, indicating higher mortality when blood pressures were lower than this threshold. Another inflection began at EDSBP 140 mm Hg. The mortality rate was 21% when EDSBP was <120 mm Hg, 9% when it was between 120 mm Hg and 140 mm Hg, and 19% when EDSBP was ≤140 mm Hg. Multivariate analysis demonstrated that patients presenting with an EDSBP of <120 mm Hg and ≤140 mm Hg were 2.7 (95% confidence interval =2.13,3.48) and 1.6 (95% confidence interval =1.32,1.96) times more likely to die, respectively, than those who presented with a EDSBP of 120 mm Hg to 140 mm Hg. Conclusions: Mortality in moderate to severe TBI has a bimodal distribution. Like hypotension, hypertension at hospital admission seems to be associated with increased mortality in TBI, even after controlling for other factors.

Original languageEnglish (US)
Pages (from-to)1179-1184
Number of pages6
JournalJournal of Trauma - Injury, Infection and Critical Care
Issue number5
StatePublished - Nov 2011
Externally publishedYes


  • Blood pressure
  • Mortality
  • Traumatic brain injury

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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