• David A Partrick, Denis D Bensard, Joseph S Janik, and Frederick M Karrer.
• Department of Pediatric Surgery, The Children's Hospital, University of Colorado, 1950 Ogden St., B-323, Denver 80218, USA. Patrick.David@tchden.org
• Am. J. Surg. 2002 Dec 1;184(6):555-9; discussion 559-60.

BackgroundTraditional surgical teaching stresses that hypotension is an indicator of loss of circulating blood volume. The purpose of this study is to critically evaluate hypotensive injured children for evidence of a hemorrhagic insult.MethodsOver a 2-year period, data were collected prospectively from children injured via a blunt mechanism. Systolic blood pressure (SBP) was recorded in the field and on arrival to the emergency department.ResultsIn all, 194 injured children were identified as hypotensive. Only 82 (42%) had identifiable injuries to account for significant volume loss. Children 0 to 5 years old had a 61% incidence of isolated head injury (46 of 76) and only a 34% incidence of hemorrhagic insult (26 of 76). Children 6 to 12 years old had a 31% incidence of isolated head injury (22 of 72) and a 52% incidence of hemorrhagic insult (38 of 72). Finally, patients more than 12 years old had a 33% incidence of isolated head injury (15 of 46) and a 39% incidence of hemorrhagic insult (18 of 46).ConclusionsHypotension should not be viewed only as a potential marker of loss of circulating volume, but also as a possible indicator of head injury in young trauma victims.

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