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Mon Apr 16 13:31:44 BST 2007

I don't know why anyone is surprised at this result. Of
course pegging a response to a number is going to lead to
mismanagement, especially when you consider that in the
case of the heart rate, the starting point can be so
variable. Apparently the concept of watching the whole
patent rather than strictly looking at numbers is passe. I
personally have always found the behavior of the heart rate
to be among the most valuable of the easily obtained
indicators of condition. And as far as it being a "vital
sign" it's certainly more of one than the pain level

R Wigle 
--- "STEWART, Paul" <PStewart at ambulance.nsw.gov.au> wrote:

> 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?