The following is a summary of “Early Abnormal Vital Signs Predict Poor Outcomes in Normotensive Patients Following Penetrating Trauma,” published in the December 2023 issue of Surgery by Alcasid et al.

In the context of penetrating trauma, identifying shock and predicting outcomes in initially normotensive patients remains a challenge. The researchers aimed to pinpoint early predictive factors linked to unfavorable outcomes in such cases. Their investigation focused on recognizing associations between initial abnormal vital signs and adverse prognosis in normotensive patients after penetrating trauma. The study group hypothesized that anomalies in the initial vital signs would serve as prognostic indicators for poor outcomes in this patient cohort. 

Through a retrospective analysis spanning 2006 to 2021 and involving trauma patients with penetrating injuries presenting with initial normotensive blood pressures (systolic blood pressure ≥90 mmHg), they compared those manifesting narrow pulse pressure (NPP ≤25% of systolic blood pressure), tachycardia (heart rate ≥100 beats per minute), and an elevated shock index (SI ≥ 0.8) to those without these signs. Their assessments included mortality rates, admission to the intensive care unit, and the need for mechanical ventilation. Univariate analyses revealed that NPP, tachycardia, and an elevated SI correlated with increased mortality compared to patients without these signs. However, in multivariable logistic regression analyses, only NPP and tachycardia are independently associated with mortality. Tachycardia and an elevated SI were independently linked to admission to the intensive care unit. Specifically, an elevated SI demonstrated an independent association with the need for mechanical ventilation, while NPP and tachycardia did not exhibit this independent association. 

These findings highlight the potential of immediate recognition of NPP and tachycardia in the trauma bay as valuable indicators independently associated with mortality and adverse outcomes in normotensive patients following penetrating trauma, thereby offering an avenue for enhanced prognostic capability in these critical scenarios.

Source: sciencedirect.com/science/article/pii/S0022480423005887