Investigators have found that hypotension may be associated with a crude odds ratio of 3.82 for mortality in patients with traumatic brain injury, indicating a nearly fourfold increased risk, according to a recent review.

In the systematic review and meta-analysis, published in JAMA Network Open, the investigators examined the data of 51 studies, encompassing 384,329 patients with moderate to severe traumatic brain injury (TBI). They assessed the association between hypotension and mortality.

The pooled analysis found that patients with hypotension had a significantly higher risk of mortality, with a crude odds ratio (OR) of 3.82 (95% confidence interval [CI] = 3.04–4.81) and an adjusted OR of 2.22 (95% CI = 1.96–2.51). The overall incidence of hypotension among these patients was 18% (95% CI = 12%–26%).

The results indicated that a systolic blood pressure (SBP) below 90 mmHg was associated with a 2.64-fold increased risk of mortality (adjusted OR = 2.64, 95% CI = 2.15–3.23). In contrast, maintaining an SBP greater than 90 mmHg reduced the risk of mortality (adjusted OR = 1.58, 95% CI = 1.40–1.78). Subgroup analyses revealed that isolated TBI was associated with a higher mortality risk compared with multiple-trauma TBI. Additionally, the timing and setting of blood pressure measurements influenced the mortality outcomes, with higher mortality observed when hypotension was measured in the emergency department compared with emergency medical services.

The findings underscored the importance of blood pressure management in patients with TBI, with careful maintenance of SBP within appropriate thresholds shown to reduce mortality. Future research should focus on stratifying hypotension duration and management strategies to further optimize clinical outcomes and support current guidelines.

Full disclosures can be found in the published review.