Background
Methods
Study design and data collection
Selection of participants and definitions
Assessment of consciousness levels in the prehospital setting
Cushing’s sign
Statistical analysis
Results
Study participants and baseline characteristics
LT-BI N = 1859 | Non LT-BI N = 4473 |
P-value | |
---|---|---|---|
Age (year), mean ± SD | 62 ± 20 | 54 ± 22 | <0.001*
|
Female, n (%) | 599 (32) | 1,272 (28) | 0.003†
|
pSBP (mmHg), mean ± SD | 152 ± 40 | 129 ± 35 | <0.001*
|
pHR (beats/min), mean ± SD | 84 ± 23 | 90 ± 24 | <0.001*
|
Chest AIS ≥ 4, n (%) | 158 (9) | 957 (21) | <0.001†
|
Abdomen AIS ≥ 4, n (%) | 10 (0.5) | 154 (3) | <0.001†
|
Extremity AIS ≥ 4, n (%) | 36 (2) | 292 (7) | <0.001†
|
ISS, median (IQR) | 25 (25, 29) | 22 (16, 34) | <0.001‡
|
Hospital mortality, n (%) | 1,075 (58) | 982 (22) | <0.001†
|
Effect of hypertension or bradycardia on prediction of LT-BI in the prehospital setting
AUROC values using pSBP, pHR, and the combination of pSBP and pHR for LT-BI in the prehospital setting
AUROC (95% CI) |
P-value | |
---|---|---|
pSBP overall | 0.666 (0.652–0.681) | <0.001 |
pHR ≤ 59 | 0.651 (0.602–0.700) | <0.001 |
60 ≤ pHR ≤ 99 | 0.680 (0.662–0.699) | <0.001 |
100 ≤ pHR ≤ 139 | 0.643 (0.611–0.675) | <0.001 |
140 ≤ pHR | 0.623 (0.532–0.715) | 0.009 |
pHR overall | 0.578 (0.563–0.594) | <0.001 |
pSBP ≤ 99 | 0.542 (0.491–0.592) | 0.088 |
100 ≤ pSBP ≤ 139 | 0.577 (0.549–0.605) | <0.001 |
140 ≤ pSBP ≤ 179 | 0.573 (0.546–0.600) | <0.001 |
180 ≤ pSBP | 0.611 (0.574–0.648) | <0.001 |
Positive predictive value, sensitivity, and specificity of the combination of pSBP and pHR for LT-BI
Sensitivity (95% CI) | Specificity (95% CI) | ||
---|---|---|---|
pSBP ≤ 99 | pHR ≤ 59 | 0.011 (0.007–0.015) | 0.985 (0.984–0.987) |
60 ≤ pHR ≤ 99 | 0.042 (0.035–0.052) | 0.900 (0.896–0.903) | |
100 ≤ pHR ≤ 139 | 0.030 (0.023–0.037) | 0.931 (0.928–0.934) | |
140 ≤ pHR | 0.006 (0.004–0.010) | 0.989 (0.988–0.991) | |
100 ≤ pSBP ≤ 139 | pHR ≤ 59 | 0.034 (0.028–0.041) | 0.975 (0.973–0.978) |
60 ≤ pHR ≤ 99 | 0.190 (0.175–0.206) | 0.706 (0.700–0.713) | |
100 ≤ pHR ≤ 139 | 0.065 (0.056–0.076) | 0.885 (0.881–0.889) | |
140 ≤ pHR | 0.006 (0.003–0.010) | 0.990 (0.989–0.992) | |
140 ≤ pSBP ≤ 179 | pHR ≤ 59 | 0.042 (0.036–0.049) | 0.982 (0.979–0.985) |
60 ≤ pHR ≤ 99 | 0.231 (0.215–0.246) | 0.829 (0.823–0.836) | |
100 ≤ pHR ≤ 139 | 0.072 (0.062–0.082) | 0.928 (0.924–0.932) | |
140 ≤ pHR | 0.009 (0.006–0.013) | 0.989 (0.988–0.991) | |
180 ≤ pSBP | pHR ≤ 59 | 0.023 (0.018–0.026) | 0.994 (0.993–0.996) |
60 ≤ pHR ≤ 99 | 0.178 (0.166–0.189) | 0.946 (0.941–0.951) | |
100 ≤ pHR ≤ 139 | 0.055 (0.047–0.063) | 0.972 (0.968–0.975) | |
140 ≤ pHR | 0.006 (0.004–0.008) | 0.997 (0.996–0.998) |
Predictive models for LT-BI using pSBP, pHR, and the combination of pSBP and pHR
Variables | Adjusted OR (95% CI) |
P-value |
---|---|---|
A | ||
pSBP ≤ 99 | 0.78 (0.64–0.95) | 0.013 |
100 ≤ pSBP ≤ 139 | 1.00 (reference) | |
140 ≤ pSBP ≤ 179 | 1.68 (1.47–1.94) | <0.001 |
180 ≤ pSBP | 3.21 (2.70–3.81) | <0.001 |
B | ||
pHR ≤ 59 | 1.67 (1.37–2.03) | <0.001 |
60 ≤ pHR ≤ 99 | 1.00 (reference) | |
100 ≤ pHR ≤ 139 | 0.90 (0.78–1.03) | 0.109 |
140 ≤ pHR | 1.20 (0.85–.1.70) | 0.292 |