Initial hypotension was the strongest predictor of hypotension on hospital arrival in adult TBI patients transported by HEMS (OR 13.82, 95% CI 11.47–16.65), with severe TBI and polytrauma as additional independent predictors.
Key Findings
Results
Hypotension on hospital arrival occurred in 3.4% of all adult TBI patients transported by HEMS.
Total cohort included 20,756 patients.
67.7% were male with a median age of 55.0 years.
Hypotension was defined as SBP < 90 mmHg in line with current German guidance.
Data were drawn from ADAC Luftrettung mission records from 2017 to 2021.
This was a retrospective cohort study of adults aged ≥18 years with documented TBI.
Results
Among patients with initial hypotension, 35.5% remained hypotensive on hospital arrival.
Initial hypotension was defined as SBP < 90 mmHg at initial HEMS contact.
Hypotension on hospital arrival was assessed as a separate time point (SBP on hospital arrival).
This subgroup represented a substantially higher rate of persistent hypotension compared to the overall prevalence of 3.4%.
This finding identifies patients with initial hypotension as a high-risk subgroup.
Results
Initial hypotension was the strongest independent predictor of hypotension on hospital arrival.
OR 13.82 (95% CI 11.47–16.65) in multivariable logistic regression.
This was the largest odds ratio among all predictors examined.
The analysis adjusted for TBI severity and injury pattern, among other variables.
Results
Severe TBI was an independent predictor of hypotension on hospital arrival.
OR 4.26 (95% CI 3.41–5.32) in multivariable logistic regression.
TBI severity was classified by Glasgow Coma Scale (GCS).
Severe TBI represented the second strongest predictor after initial hypotension.
Results
Polytrauma was an independent predictor of hypotension on hospital arrival.
OR 3.08 (95% CI 2.44–3.90) in multivariable logistic regression.
Injury patterns were recorded as isolated TBI, multiple injuries (non-polytrauma; 'Mehrfachverletzung'), or polytrauma.
Polytrauma was the third strongest independent predictor identified.
Results
The study population was predominantly male with a middle-aged median demographic.
67.7% of the 20,756 included patients were male.
Median age was 55.0 years.
All patients were adults aged ≥18 years transported by HEMS across a five-year period (2017–2021).
Macaitė A, Scholl L, Schwietring J, Rehberg S, Hoyer A, Thies K. (2026). Prevalence and predictors of hypotension on hospital arrival in traumatic brain injury: a prehospital HEMS cohort study.. Scientific reports. https://doi.org/10.1038/s41598-026-45208-7