• S R Heckbert, N B Vedder, W Hoffman, R K Winn, L D Hudson, G J Jurkovich, M K Copass, J M Harlan, C L Rice, and R V Maier.
• Department of Epidemiology, University of Washington, Seattle, USA.
• J Trauma. 1998 Sep 1;45(3):545-9.

BackgroundIt is essential to identify patients at high risk of death and complications for future studies of interventions to decrease reperfusion injury.MethodsWe conducted an inception cohort study at a Level I trauma center to determine the rates and predictors of death, organ failure, and infection in trauma patients with systolic blood pressure < or = 90 mm Hg in the field or in the emergency department.ResultsAmong the 208 patients with hemorrhagic shock (blood pressure < or = 90 mm Hg), 31% died within 2 hours of emergency department arrival, 12% died between 2 and 24 hours, 11% died after 24 hours, and 46% survived. Among those who survived > or = 24 hours, 39% developed infection and 24% developed organ failure. Increasing volume of crystalloid in the first 24 hours was strongly associated with increased mortality (p = 0.00001).ConclusionHemorrhage-induced hypotension in trauma patients is predictive of high mortality (54%) and morbidity. The requirement for large volumes of crystalloid was associated with increased mortality.

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