Systemic hypotension is a late marker of shock after trauma: a validation study of Advanced Trauma Life Support principles in a large national sample

Am J Surg. 2006 Dec;192(6):727-31. doi: 10.1016/j.amjsurg.2006.08.034.


Background: Systolic blood pressure is used extensively to triage trauma patients as stable or unstable, contrary to Advanced Trauma Life Support recommendations. We hypothesized that systemic hypotension is a late marker of shock.

Methods: The National Trauma Data Bank was queried (n = 115,830). Base deficit was used as a measure of circulatory shock. Systolic blood pressure was correlated with the presence and the severity of base-deficit derangement.

Results: Systolic blood pressure correlated poorly with base deficit (r = .28). There was wide variation in systolic blood pressure within each base-deficit group. The mean and median systolic blood pressure did not decrease to less than 90 mm Hg until the base deficit was worse than -20, with mortality reaching 65%.

Conclusions: We validated the Advanced Trauma Life Support principle that systemic hypotension is a late marker of shock. A normal blood pressure should not deter aggressive evaluation and resuscitation of trauma patients.

MeSH terms

  • Adult
  • Databases as Topic
  • Female
  • Humans
  • Hypotension / etiology*
  • Hypotension / therapy
  • Male
  • Resuscitation / methods*
  • Shock, Hemorrhagic / etiology
  • Shock, Hemorrhagic / therapy*
  • Time Factors
  • Triage
  • Wounds and Injuries / complications
  • Wounds and Injuries / therapy*