Heart rate variability is an independent predictor of morbidity and mortality in hemodynamically stable trauma patients

Mark L. Ryan, Michael P. Ogilvie, Bruno M T Pereira, Juan Carlos Gomez-Rodriguez, Ronald J. Manning, Paola A. Vargas, Robert C. Duncan, Kenneth G Proctor

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

BACKGROUND: Reduced heart rate variability (HRV) reflects autonomic dysfunction and can triage patients better than routine trauma criteria or vital signs. However, there is questionable specificity and no consensus measurement technique. The purpose of this study was to analyze whether factors that alter autonomic function affect the specificity of HRV for assessing traumatic injury. METHODS: We evaluated 216 hemodynamically stable adults (3:1 M:F; 97:3 blunt:penetrating; age 49 years ± 1 year, mean ± standard error) undergoing computed axial tomography (CT) scan to rule out traumatic brain injury (TBI). All were prospectively instrumented with a Mars Holter system (GE Healthcare, Milwaukee, WI). HRV was determined offline using time domain (standard deviation of normal-normal intervals, root-mean-square successive difference) and frequency domain (very low frequency [VLF], LF, wideband frequency, high frequency [HF], low to HF index ratio) calculations from 15-minute electrocardiogram and correlated with routine vital signs, mortality, TBI, morbidity, length of stay (LOS), and comorbidities. Significance (p ≤ 0.05) was determined using nonparametric analysis, Student's t test, analysis of variance, or multiple logistic regression. RESULTS: VLF alone predicted survival, severity of TBI, intensive care unit LOS, and hospital LOS (all p < 0.05). Beta-blockers or diabetes had no effect, whereas age, sedation, mechanical ventilation, spinal cord injury, and intoxication influenced one or more of the variables with age being the most powerful confounder (all p < 0.05). Except for the Glasgow Coma Scale, no other routine trauma or hemodynamic criteria correlated with any of these outcomes. CONCLUSIONS: Decreased VLF is an independent predictor of mortality and morbidity in hemodynamically stable trauma patients. Other time and other frequency domain variables correlated with some, but not all, outcomes. All were heavily influenced by factors that alter autonomic function, especially patient age.

Original languageEnglish
Pages (from-to)1371-1379
Number of pages9
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume70
Issue number6
DOIs
StatePublished - Jun 1 2011

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Length of Stay
Heart Rate
Morbidity
Mortality
Vital Signs
Wounds and Injuries
Mars
Glasgow Coma Scale
Triage
Spinal Cord Injuries
Artificial Respiration
Statistical Factor Analysis
Intensive Care Units
Comorbidity
Analysis of Variance
Electrocardiography
Logistic Models
Hemodynamics
Tomography
Students

Keywords

  • Computed axial tomography
  • ECG
  • Heart rate variability
  • Traumatic brain injury

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Heart rate variability is an independent predictor of morbidity and mortality in hemodynamically stable trauma patients. / Ryan, Mark L.; Ogilvie, Michael P.; Pereira, Bruno M T; Gomez-Rodriguez, Juan Carlos; Manning, Ronald J.; Vargas, Paola A.; Duncan, Robert C.; Proctor, Kenneth G.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 70, No. 6, 01.06.2011, p. 1371-1379.

Research output: Contribution to journalArticle

Ryan, Mark L. ; Ogilvie, Michael P. ; Pereira, Bruno M T ; Gomez-Rodriguez, Juan Carlos ; Manning, Ronald J. ; Vargas, Paola A. ; Duncan, Robert C. ; Proctor, Kenneth G. / Heart rate variability is an independent predictor of morbidity and mortality in hemodynamically stable trauma patients. In: Journal of Trauma - Injury, Infection and Critical Care. 2011 ; Vol. 70, No. 6. pp. 1371-1379.
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AU - Manning, Ronald J.

AU - Vargas, Paola A.

AU - Duncan, Robert C.

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KW - Computed axial tomography

KW - ECG

KW - Heart rate variability

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