1151. Is heart rate variability better than routine vital signs for prehospital identification of major hemorrhage?
- Author
-
Robert Carter, Andrew T. Reisner, Jaques Reifman, Shwetha Edla, Victor A. Convertino, and Jianbo Liu
- Subjects
Adult ,Male ,Emergency Medical Services ,medicine.medical_specialty ,Blood transfusion ,Multivariate analysis ,medicine.medical_treatment ,Vital signs ,Hemorrhage ,Heart Rate ,Heart rate ,medicine ,Humans ,Heart rate variability ,Intensive care medicine ,Retrospective Studies ,medicine.diagnostic_test ,Receiver operating characteristic ,Vital Signs ,business.industry ,Retrospective cohort study ,General Medicine ,Emergency Medicine ,Wounds and Injuries ,Female ,Erythrocyte Transfusion ,business ,Electrocardiography - Abstract
ObjectiveDuring initial assessment of trauma patients, metrics of heart rate variability (HRV) have been associated with high-risk clinical conditions. Yet, despite numerous studies, the potential of HRV to improve clinical outcomes remains unclear. Our objective was to evaluate whether HRV metrics provide additional diagnostic information, beyond routine vital signs, for making a specific clinical assessment: identification of hemorrhaging patients who receive packed red blood cell (PRBC) transfusion.MethodsAdult prehospital trauma patients were analyzed retrospectively, excluding those who lacked a complete set of reliable vital signs and a clean electrocardiogram for computation of HRV metrics. We also excluded patients who did not survive to admission. The primary outcome was hemorrhagic injury plus different PRBC transfusion volumes. We performed multivariate regression analysis using HRV metrics and routine vital signs to test the hypothesis that HRV metrics could improve the diagnosis of hemorrhagic injury plus PRBC transfusion vs routine vital signs alone.ResultsAs univariate predictors, HRV metrics in a data set of 402 subjects had comparable areas under receiver operating characteristic curves compared with routine vital signs. In multivariate regression models containing routine vital signs, HRV parameters were significant (P < .05) but yielded areas under receiver operating characteristic curves with minimal, nonsignificant improvements (+0.00 to +0.05).ConclusionsA novel diagnostic test should improve diagnostic thinking and allow for better decision making in a significant fraction of cases. Our findings do not support that HRV metrics add value over routine vital signs in terms of prehospital identification of hemorrhaging patients who receive PRBC transfusion.
- Full Text
- View/download PDF