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Mon Apr 16 12:18:03 BST 2007

Did someone really analyze 10,825 patients to get to this earth shattering decision that " Heart rate alone is not sufficient to determine the need for emergent interventions for hemorrhage"?  
Paul Stewart
Clinical Development
Ambulance Service of New South Wales
Mobile: 0422004101
pstewart at ambulance.nsw.gov.au

________________________________

From: S Schecter [https://internal.ambulance.nsw.gov.au/CitrixFEI/composemessage.asp?to=schecters@gmail.com]
Sent: Mon 4/16/2007 11:14 AM
To: Trauma &amp, Critical Care mailing list
Subject: Heart Rate: Is It Truly a Vital Sign?

Journal of Trauma-Injury Infection & Critical Care. 62(4):812-817,
April 2007.
Brasel, Karen J. MD, MPH; Guse, Clare MS; Gentilello, Larry M. MD;
Nirula, Ram MD, MPH
Abstract:

Background: Tachycardia, often defined as heart rate >100 bpm, has
been
utilized as a physical sign of hypovolemic shock among the injured
for
decades without evidence to support its use as a predictor of injury
or
significant hypovolemia. We sought to determine whether admission
heart
rate is a valid predictor of hemodynamically significant injuries.

Methods: Trauma registry data from 1998 to 2004 were analyzed with
logistic regression to determine whether heart rate was associated
with
need for emergent intervention for bleeding (laparotomy, thoracotomy,
or angiography) , need for packed red blood cell (pRBC) transfusion in
the first 24 hours, or severe injury (ISS >25) after blunt or
penetrating trauma.

Results: Records of 10,825 patients were analyzed. Overall, heart
rate
was neither sensitive nor specific in determining the need for
emergent
intervention, pRBCs in the first 24 hours or severe injury. This was
not altered by the presence of hypotension (systolic blood pressure
<90
mm Hg) or age in the blunt cohort.

Conclusions: Heart rate alone is not sufficient to determine the need
for emergent interventions for hemorrhage. Although tachycardia may
still indicate need for emergent intervention in the trauma patient,
its absence should not allay such concern.

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Heart Rate: Is It Truly a Vital Sign?