Ahmed K, El-Menyar A, Asim M, Al Jogol H, Taha I, Kanbar A, Younis B, Rizoli S, Al-Thani H. Prognostic utility of on-admission pulse pressure in hospitalized patients with traumatic brain injury. World J Crit Care Med 2026; 15(3): 115627 [DOI: 10.5492/wjccm.115627]
Corresponding Author of This Article
Ayman El-Menyar, MD, Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Al-Rayyan Street, Doha 3050, Qatar. aymanco65@yahoo.com
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Emergency Medicine
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research-article
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Ahmed K, El-Menyar A, Asim M, Al Jogol H, Taha I, Kanbar A, Younis B, Rizoli S, Al-Thani H. Prognostic utility of on-admission pulse pressure in hospitalized patients with traumatic brain injury. World J Crit Care Med 2026; 15(3): 115627 [DOI: 10.5492/wjccm.115627]
World J Crit Care Med. Sep 9, 2026; 15(3): 115627 Published online Sep 9, 2026. doi: 10.5492/wjccm.115627
Prognostic utility of on-admission pulse pressure in hospitalized patients with traumatic brain injury
Khalid Ahmed, Ayman El-Menyar, Mohammad Asim, Hisham Al Jogol, Ibrahim Taha, Ahad Kanbar, Basil Younis, Sandro Rizoli, Hassan Al-Thani
Khalid Ahmed, Ayman El-Menyar, Mohammad Asim, Hisham Al Jogol, Ibrahim Taha, Ahad Kanbar, Basil Younis, Sandro Rizoli, Hassan Al-Thani, Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha 3050, Qatar
Ayman El-Menyar, Department of Clinical Medicine, Weill Cornell Medicine, Doha 24144, Qatar
Co-first authors: Khalid Ahmed and Ayman El-Menyar.
Author contributions: Ahmed K and El-Menyar A contributed to the conceptualization of the study and contributed equally to this manuscript as co-first authors; El-Menyar A and Asim M contributed to study methodology; Al Jogol H, Taha I, Kanbar A, and Younis B contributed to data curation; Ahmed K participated in the original draft preparation; Rizoli S and Al-Thani H reviewed and edited the manuscript. All authors have read and approved the final version of the manuscript.
Institutional review board statement: This retrospective study was approved by the Medical Research Center Institutional Review Board (approval no: MRC-01-21-990).
Informed consent statement: Patients were not required to provide informed consent for this study because the analysis used anonymized clinical data obtained after each patient had provided written informed consent for treatment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All relevant data are presented in the manuscript, figures, and tables.
Corresponding author: Ayman El-Menyar, MD, Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Al-Rayyan Street, Doha 3050, Qatar. aymanco65@yahoo.com
Received: October 22, 2025 Revised: November 19, 2025 Accepted: January 27, 2026 Published online: September 9, 2026 Processing time: 309 Days and 19.1 Hours
Abstract
BACKGROUND
Traumatic brain injury (TBI) remains a significant cause of morbidity and mortality worldwide. Given the pivotal role of proper triage and timely management in patients with TBI, physicians are seeking a readily informative, straightforward tool for evaluating patients in the emergency department.
AIM
To evaluate the association between on-admission pulse pressure (PP) and clinical outcomes, including severity of injury, complications, and mortality, among patients hospitalized with TBI.
METHODS
A retrospective observational study was conducted using data from adult patients with TBI admitted to the Hamad Trauma Center from 2011 to 2021. Patients were categorized into five PP groups at presentation in the emergency department: ≤ 30 mmHg, 31-40 mmHg, 41-50 mmHg, 51-60 mmHg, and > 60 mmHg.
RESULTS
A total of 5029 patients with TBI (mean age 33.1 ± 12.6 years; 87% male) were included. Low PP (PP ≤ 30) was significantly associated with younger age; higher injury severity; worse physiological parameters; and increased rates of transfusion, intubation, and acute respiratory distress syndrome (P < 0.001). Mortality was higher in the low-PP group (24%) compared with mid- and high-PP groups (5%-7%, P < 0.001). Bivariate analysis revealed that PP was positively correlated with age (r = 0.21), mean arterial pressure (r = 0.35), and Glasgow Coma Scale score (r = 0.098), and negatively correlated with shock index (r = -0.47), Injury Severity Score (r = -0.115), and blood units transfused (r = -0.18). Multivariable regression identified age, head Abbreviated Injury Scale score, PP, transfused blood units, and acute respiratory distress syndrome as independent predictors of mortality (P < 0.001).
CONCLUSION
Admission PP reflects both hemodynamic stability and injury severity in patients with TBI. Low PP (≤ 30 mmHg) independently predicts higher mortality, whereas moderate PP (41-60 mmHg) is associated with optimal outcomes, suggesting this range represents a potential hemodynamic target. PP is a simple, rapid bedside adjunct marker that may aid early risk stratification and guide timely intervention in the management of TBI.
Core Tip: Traumatic brain injury is a major contributor to long-term disability. Hemodynamic parameters, including mean arterial pressure and pulse pressure (PP), play a critical role in maintaining cerebral perfusion, regulating intracranial pressure, and mitigating secondary brain injury. Admission PP reflects both hemodynamic stability and injury severity in patients with brain injury. Low PP (≤ 30 mmHg) independently predicts higher mortality, whereas moderate PP is associated with optimal outcomes, suggesting that this range represents a potential hemodynamic target. PP is a simple bedside adjunct marker that aids early risk stratification and guides timely intervention in patients with traumatic brain injury.
