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Nontraumatic hypotension and shock in the emergency department and the prehospital setting, prevalence, etiology, and mortality: a systematic review.

Holler JG, Bech CN, Henriksen DP, Mikkelsen S, Pedersen C, Lassen AT - PLoS ONE (2015)

Bottom Line: There is inadequate evidence to establish concise estimates of the characteristics of nontraumatic hypotension and shock in the ED or in the prehospital setting.The inhospital mortality of prehospital shock is 33-52%.Prevalence, etiology and mortality of shock in the ED are not well described.

View Article: PubMed Central - PubMed

Affiliation: Department of Emergency Medicine, Odense University Hospital, Odense, Denmark.

ABSTRACT

Background: Acute patients presenting with hypotension in the prehospital or emergency department (ED) setting are in need of focused management and knowledge of the epidemiology characteristics might help the clinician. The aim of this review was to address prevalence, etiology and mortality of nontraumatic hypotension (SBP ≤ 90 mmHg) with or without the presence of shock in the prehospital and ED setting.

Methods: We performed a systematic literature search up to August 2013, using Medline, Embase, Cinahl, Dare and The Cochrane Library. The analysis and eligibility criteria were documented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-guidelines) and The Cochrane Collaboration. No restrictions on language, publication date, or status were imposed. We used the Newcastle-Ottawa quality assessment scale (NOS-scale) and the Strengthening the Reporting of Observational studies in Epidemiology (STROBE-statement) to assess the quality.

Results: Six observational studies were considered eligible for analysis based on the evaluation of 11,880 identified papers. Prehospital prevalence of hypotension was 19.5/1000 emergency medicine service (EMS) contacts, and the prevalence of hypotensive shock was 9.5-19/1000 EMS contacts with an inhospital mortality of shock between 33 to 52%. ED prevalence of hypotension was 4-13/1000 contacts with a mortality of 12%. Information on mortality, prevalence and etiology of shock in the ED was limited. A meta-analysis was not feasible due to substantial heterogeneity between studies.

Conclusion: There is inadequate evidence to establish concise estimates of the characteristics of nontraumatic hypotension and shock in the ED or in the prehospital setting. The available studies suggest that 2% of EMS contacts present with nontraumatic hypotension while 1-2% present with shock. The inhospital mortality of prehospital shock is 33-52%. Prevalence of hypotension in the ED is 1% with an inhospital mortality of 12%. Prevalence, etiology and mortality of shock in the ED are not well described.

No MeSH data available.


Related in: MedlinePlus

In-hospital mortality based on setting and presence of hypotension (Jones et al. 2006) and hypotensive shock (Poloudoff et al. and Jones et al. 2004).
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pone.0119331.g004: In-hospital mortality based on setting and presence of hypotension (Jones et al. 2006) and hypotensive shock (Poloudoff et al. and Jones et al. 2004).

Mentions: It was possible to retrieve data on mortality from three studies (see Fig. 3 and Fig. 4) [30, 32, 46]. The inhospital mortality of patients already recognized with shock prehospitally was 33% to 52% [32, 46]. No data were available regarding patients suffering hypotension in the prehospital setting. Among hypotensive patients in the ED the inhospital mortality was 12% [30]. It was not possible to retrieve information on mortality regarding shock in the ED.


Nontraumatic hypotension and shock in the emergency department and the prehospital setting, prevalence, etiology, and mortality: a systematic review.

Holler JG, Bech CN, Henriksen DP, Mikkelsen S, Pedersen C, Lassen AT - PLoS ONE (2015)

In-hospital mortality based on setting and presence of hypotension (Jones et al. 2006) and hypotensive shock (Poloudoff et al. and Jones et al. 2004).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4366173&req=5

pone.0119331.g004: In-hospital mortality based on setting and presence of hypotension (Jones et al. 2006) and hypotensive shock (Poloudoff et al. and Jones et al. 2004).
Mentions: It was possible to retrieve data on mortality from three studies (see Fig. 3 and Fig. 4) [30, 32, 46]. The inhospital mortality of patients already recognized with shock prehospitally was 33% to 52% [32, 46]. No data were available regarding patients suffering hypotension in the prehospital setting. Among hypotensive patients in the ED the inhospital mortality was 12% [30]. It was not possible to retrieve information on mortality regarding shock in the ED.

Bottom Line: There is inadequate evidence to establish concise estimates of the characteristics of nontraumatic hypotension and shock in the ED or in the prehospital setting.The inhospital mortality of prehospital shock is 33-52%.Prevalence, etiology and mortality of shock in the ED are not well described.

View Article: PubMed Central - PubMed

Affiliation: Department of Emergency Medicine, Odense University Hospital, Odense, Denmark.

ABSTRACT

Background: Acute patients presenting with hypotension in the prehospital or emergency department (ED) setting are in need of focused management and knowledge of the epidemiology characteristics might help the clinician. The aim of this review was to address prevalence, etiology and mortality of nontraumatic hypotension (SBP ≤ 90 mmHg) with or without the presence of shock in the prehospital and ED setting.

Methods: We performed a systematic literature search up to August 2013, using Medline, Embase, Cinahl, Dare and The Cochrane Library. The analysis and eligibility criteria were documented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-guidelines) and The Cochrane Collaboration. No restrictions on language, publication date, or status were imposed. We used the Newcastle-Ottawa quality assessment scale (NOS-scale) and the Strengthening the Reporting of Observational studies in Epidemiology (STROBE-statement) to assess the quality.

Results: Six observational studies were considered eligible for analysis based on the evaluation of 11,880 identified papers. Prehospital prevalence of hypotension was 19.5/1000 emergency medicine service (EMS) contacts, and the prevalence of hypotensive shock was 9.5-19/1000 EMS contacts with an inhospital mortality of shock between 33 to 52%. ED prevalence of hypotension was 4-13/1000 contacts with a mortality of 12%. Information on mortality, prevalence and etiology of shock in the ED was limited. A meta-analysis was not feasible due to substantial heterogeneity between studies.

Conclusion: There is inadequate evidence to establish concise estimates of the characteristics of nontraumatic hypotension and shock in the ED or in the prehospital setting. The available studies suggest that 2% of EMS contacts present with nontraumatic hypotension while 1-2% present with shock. The inhospital mortality of prehospital shock is 33-52%. Prevalence of hypotension in the ED is 1% with an inhospital mortality of 12%. Prevalence, etiology and mortality of shock in the ED are not well described.

No MeSH data available.


Related in: MedlinePlus