Letters

Accuracy of ATLS guidelines for predicting systolic blood pressure

BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7285.552 (Published 03 March 2001) Cite this as: BMJ 2001;322:552

Authors' core assertion was wrong

  1. Ian S Russell (iona.macleod@nth.northy.nhs.uk), staff grade
  1. Department of Accident and Emergency, Hartlepool General Hospital, Hartlepool TS24 9AH
  2. Minlaton Accident and Emergency Department, Minlaton, South Australia, Australia
  3. Royal Gwent Hospital, Newport, Gwent NP9 2UB
  4. Shackleton Department of Anaesthetics, Southampton General Hospital NHS Trust, Southampton SO16 6YD

    EDITOR—I commend the BMJ for allowing access to the editorial decision making process via the BMJ's website. It gives a fair measure of explanation why a paper was published.

    On reading the peer reviews for Deakin and Low's paper on advanced trauma life support guidelines for predicting systolic blood pressure it is evident that the referee and statistician have accepted without criticism the authors' core assertion.1 This is that the advanced trauma life support course teaches that if only the patient's carotid pulse is palpable then the systolic blood pressure is 60–70 mm Hg; if both the carotid and femoral pulses are palpable then the systolic blood pressure is 70–80 mm Hg; and if the radial pulse is also palpable then the systolic blood pressure is >80 mm Hg.

    Unfortunately, this is entirely wrong and constitutes no part of the current course or manual.2 The authors cite a guideline from 1985,3 but the manual is currently in its sixth edition, with a further update due for publication this year, 2001.

    One redeeming feature of the paper is that it shows (albeit at lower intra-arterial systolic pressures) an observable relation between the palpability of pulses and systolic blood pressure. But the design of the paper is open to question. Why were only 20 patients included …

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