Outcome after hemorrhagic shock in trauma patients

Background: It is essential to identify patients at high risk of death and complications for future studies of interventions to decrease reperfusion injury. Methods: We 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 ≤ 90 mm Hg in the field or in the emergency department. Results: Among the 208 patients with hemorrhagic shock (blood pressure ≤ 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 ≥ 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). Conclusion: Hemorrhage-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.