Admission Hypotension Remains Lethal in Traumatic Brain Injury Despite Modern Resuscitation

Tuesday, March 24, 2026

10:00 AM - 11:00 AM Central Time

Location: Connections Central - RST 17

MC

Minahil Cheema, Bs

Disclosure(s): No relevant financial relationship(s) to disclose.
AC

Aamna Cheema, Bs

Student
University of Maryland School of Medicine

Disclosure information not submitted.
SJ

Shriya Jaddu, BS

Student
Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine,University of Maryland School of Medicine

Disclosure information not submitted.
AT

Anastasia Ternovskaia, BS

Student
University of Maryland School of Medicine

Disclosure information not submitted.
TK

Taylor Kowansky, BS

Student
Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine,University of Maryland School of Medicine

Disclosure information not submitted.
PM

Patrick McGinnis, BS

Medical Student
University of Maryland School of Medicine

Disclosure information not submitted.
JS

Japneet Singh, BS

Student
Research Associate Program in Emergency Medicine & Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine

Disclosure information not submitted.
Jessica Downing, MD

University of Maryland Medical Center, Maryland

Disclosure information not submitted.
Emily Esposito, DO (she/her/hers)

University of Maryland Medical Center, R. Adams Cowley Shock Trauma Center, Maryland

Disclosure(s): No relevant financial relationship(s) to disclose.
Quincy K. Tran, MD, PhD

University of Maryland Medical Center, R. Adams Cowley Shock Trauma Center, Maryland

Disclosure information not submitted.

Introduction: Brief low blood pressure after traumatic brain injury (TBI) may still precipitate secondary cerebral ischemia. Although rapid blood‑product delivery and damage‑control resuscitation are now standard, it is unclear whether these advances mitigate the classic mortality risk of hypotension in traumatic brain injury (TBI). We evaluated admission blood pressure (BP) as a predictor of outcome in a contemporary cohort at a high‑volume trauma center.

Methods: Adults with TBI admitted to the R Adams Cowley Shock Trauma Center, 2017-2021, were retrospectively reviewed. Hypotension was defined as systolic BP (SBP) < 90 mmHg or diastolic BP (DBP) < 60 mmHg on arrival. Primary outcome: in‑hospital mortality. Secondary outcomes: ICU/ventilator days, and hospital length of stay (LOS). We used chi-square test for categorical data, and Mann‑Whitney U and Spearman correlation for continuous variables.

Results: Among 3,094 patients, SBP and DBP hypotension occurred in 29 patients (0.9 %) and 85 patients (3.1% of those with DBP measured), respectively. SBP hypotension increased mortality to 41.4 % (Relative Risk [RR] 4.6, p < 0.001) while DBP hypotension increased death risk to 16.5 % (RR 1.81,  p = 0.022). Higher SBP correlated with better neurologic status (ρ = 0.094, p < 0.0001) and fewer ventilator days (ρ = ‑0.048, p = 0.007). DBP showed a socioeconomic gradient: 86.7 mmHg in the lowest vs 83.3 mmHg in the highest income quartile (p = 0.0003), while neither SBP nor DBP differed by rural status (SBP 150.8 vs 149.3 mmHg; p = 0.49). MAP and pulse-pressure analyses mirrored these patterns.

Conclusions: Even a single admission SBP < 90 mmHg confers a four‑fold mortality risk, and DBP hypotension independently signals danger despite its greater prevalence. Blood‑pressure profiles did not mediate rural outcome gaps, but elevated DBP in lower‑income patients suggests chronic cardiovascular burdens influencing acute presentation. Universal, aggressive hemodynamic optimization and hypertension‑prevention strategies targeting disadvantaged communities are warranted.