PATIENTS with traumatic brain injury (TBI) and hypotension have a significantly increased risk of mortality, underscoring the importance of precise blood pressure management in clinical settings.
Traumatic brain injury is a leading cause of global death and disability, with over 60 million cases annually. Hypotension, a common secondary complication in TBI, exacerbates outcomes by contributing to higher mortality and long-term disability. Current guidelines recommend maintaining systolic blood pressure (SBP) thresholds to mitigate risks, but evidence supporting these standards has been insufficient, necessitating further investigation.
This systematic review and meta-analysis included 51 studies encompassing 384,329 patients, with data sourced from several major medical databases. Studies were screened and analysed according to established guidelines, including PRISMA and MOOSE. The analysis revealed a pooled mortality odds ratio of 3.82 (95% CI, 3.04-4.81; P<0.001) in patients with hypotension, with adjusted odds ratio analysis further confirming these findings (OR 2.22; 95% CI, 1.96-2.51; P<0.001). Hypotension incidence was estimated at 18% (95% CI, 12%-26%), with substantial variability across studies (I² = 96.98%). Despite the heterogeneity, the results consistently demonstrated a strong association between hypotension and adverse outcomes, including death.
The findings highlight the critical need for optimised blood pressure management in patients with TBI. This study emphasises maintaining SBP above recommended thresholds to improve survival and neurological outcomes. Future research should focus on refining BP management protocols and integrating additional patient-specific factors to enhance treatment precision. By providing robust evidence, this meta-analysis strengthens the case for revisiting current clinical guidelines, ensuring better outcomes for TBI patients.
Reference
Lee JW et al. Hypotension and adverse outcomes in moderate to severe traumatic brain injury: a systematic review and meta-analysis. JAMA Netw Open. 2024;7(11):e2444465.
