Prognostic utility of on-admission pulse pressure in hospitalized patients with traumatic brain injury.

BACKGROUND: Traumatic brain injury (TBI) remains a significant cause of morbidity and mortality worldwide. Given the pivotal role of proper triage and timely management in patients with TBI, physicians are seeking a readily informative, straightforward tool for evaluating patients in the emergency department. AIM: To evaluate the association between on-admission pulse pressure (PP) and clinical outcomes, including severity of injury, complications, and mortality, among patients hospitalized with TBI. METHODS: A retrospective observational study was conducted using data from adult patients with TBI admitted to the Hamad Trauma Center from 2011 to 2021. Patients were categorized into five PP groups at presentation in the emergency department: ≤ 30 mmHg, 31-40 mmHg, 41-50 mmHg, 51-60 mmHg, and > 60 mmHg. RESULTS: A total of 5029 patients with TBI (mean age 33.1 ± 12.6 years; 87% male) were included. Low PP (PP ≤ 30) was significantly associated with younger age; higher injury severity; worse physiological parameters; and increased rates of transfusion, intubation, and acute respiratory distress syndrome (P < 0.001). Mortality was higher in the low-PP group (24%) compared with mid- and high-PP groups (5%-7%, P < 0.001). Bivariate analysis revealed that PP was positively correlated with age (r = 0.21), mean arterial pressure (r = 0.35), and Glasgow Coma Scale score (r = 0.098), and negatively correlated with shock index (r = -0.47), Injury Severity Score (r = -0.115), and blood units transfused (r = -0.18). Multivariable regression identified age, head Abbreviated Injury Scale score, PP, transfused blood units, and acute respiratory distress syndrome as independent predictors of mortality (P < 0.001). CONCLUSION: Admission PP reflects both hemodynamic stability and injury severity in patients with TBI. Low PP (≤ 30 mmHg) independently predicts higher mortality, whereas moderate PP (41-60 mmHg) is associated with optimal outcomes, suggesting this range represents a potential hemodynamic target. PP is a simple, rapid bedside adjunct marker that may aid early risk stratification and guide timely intervention in the management of TBI.