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Prehospital pulse pressure flags trauma bleeding
Pre-hospital pulse pressure as an early predictor of active hemorrhage in trauma patients
Injury · 2026-10-15 · Added 26 October 2026
A retrospective study of 2,177 adult trauma patients across three Canadian level 1 trauma centres found prehospital pulse pressure predicted active haemorrhage (AUC 0.73), with each 10 mmHg narrowing raising the odds by 51% and a cut-off of ≤45 mmHg most useful for ruling bleeding out.
- Study type
- Cohort
- Design
- Retrospective multicentre cohort
- Participants
- 2,177 adult trauma patients (68 with active haemorrhage)
- Main finding
- Prehospital pulse pressure predicted active haemorrhage (AUC 0.73, similar to SBP 0.74); each 10 mmHg narrowing raised the odds by 51% (OR 1.51, 95% CI 1.28–1.79), and PP ≤45 mmHg was best for rule-out given high negative predictive value
- Caveat
- Retrospective design with only 68 bleeding patients, so the cut-off needs prospective validation
- Bottom line
- Hypothesis-generating
Why it matters in Australia (High relevance). Pulse pressure is just two numbers off the cuff you already take — no new equipment or drugs, so it applies to Australian practice as it stands. The outcome (transfusion or haemorrhage control) is hospital-side, but the flag is raised on scene.
Learning goal
Recognise narrowing pulse pressure as an early sign of haemorrhage in trauma patients before blood pressure falls.
More
- Topic: Trauma
- Daily scan: 26 October 2026
- Podcast: Paramedic Papers Daily, 26 October 2026
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