Objective: To assess the impact of presenting tachycardia on emergency department (ED) arrival for multiple trauma patients with severe traumatic brain injury (TBI).
Materials and Methods: Using retrospective analysis at our Level I trauma center between 2007 and 2009, we identified blunt multiple trauma patients who had severe TBI, which was defined as an abbreviated injury score (AIS) ≥4. Tachycardia was defined as a heart rate (HR) of ≥100 bpm. Patients who were <15 years of age, in cardiac arrest on arrival, those having spinal cord injury, uncontrolled arterial fibrillation, chronic heart failure or hemorrhagic shock were excluded. Outcome was investigated using the Glasgow Outcome Scale at hospital discharge. Two study groups, “good outcome” (GO; good recovery or moderate disability) and “worse outcome” (WO; severe disability, considerable vegetative state, or death) group were compared.
Results: 643 patients had head injury and 34 patients had severe TBI with multiple injuries. Mean injury severity score (ISS), shock index, and revised trauma score (RTS) were 31 ± 8, 0.59 ± 0.2, and 6.44 ± 1.3, respectively. Median Acute Physiology and Chronic Health Evaluation (APACHE) II score was 22. Ten of 34 patients were tachycardiac on ED arrival. In the WO group, the number of patients with tachycardia, Glasgow Coma Scale <9 patients, mean RTS, and APACHE II scores were higher than those in the GO group. Multivariate logistic regression analysis showed that presenting tachycardia and an APACHE II score of >22 were independent predictors of worse outcome (odds ratio, 17.6 and 27.7, respectively).
Conclusion: Presenting tachycardia on ED presentation is a crucial parameter for worse outcomes in trauma patients, who will develop worse outcome, with severe TBI suffering form non-hemorrhagic shock. Further studies of pharmacological stabilization using b-blockers during primary resuscitation and their effect on cerebral metabolism are warranted.