We did not intend to investigate in our study the known poorer outcome in hypotensive patients with multiple injuries, but this conclusion has been confirmed again by the data collected in our study.
The key message of our study was, however, the risk of trauma patients with pre-hospital arterial hypertension, whether transient or persistent.
We thank our correspondents for mentioning the high mortality associated with subdural hematoma, which undoubtedly had a negative effect on the outcomes in the hypertension group.
Further analysis of the proportional distribution of the Abbreviated Injury Scale scores for the head in the respective subgroups would have not resulted in a different conclusion. The low injury severity score in the hypertension group is indeed due to the smaller amount of severe comorbid injuries. The older average age as a predictor of a poorer prognosis in this group needs to be borne in mind. Whether the lower pre-hospital intubation rate affected the result is the subject of interpretation only but cannot significantly analyzed by using the available data from the trauma registry. However, further studies are planned with regard to excluding potential confounders.
Dr. med. Daniel Miersch, Düsseldorf
Conflict of interest statement
The authors of all contributions declare that no conflict of interest exists.
|1.||Sellmann T, Miersch D, Kienbaum P, Flohé S, Schneppendahl J, Lefering R: The impact of arterial hypertension on polytrauma and traumatic brain injury. Dtsch Arztebl Int 2012; 109(49): 849–56. VOLLTEXT|