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Improving the prediction of mortality and the need for life-saving interventions in trauma patients using standard vital signs with heart-rate variability and complexity

Nehemiah T Liu, John B Holcomb, Charles E Wade, Jose Salinas
Shock 2015, 43 (6): 549-55
25692260
The goal of this study was to determine the effectiveness of using traditional and new vital signs (heart rate variability and complexity [HRV, HRC]) for predicting mortality and the need for life-saving interventions (LSIs) in prehospital trauma patients. Our hypothesis was that statistical regression models using traditional and new vital signs would be superior in predictive performance over models using standard vital signs alone. This study involved 108 prehospital trauma patients transported from the point of injury via helicopter. Heart rate variability and HRC were calculated using criterion standard R-R interval sequences manually verified from the patients' electrocardiograms. Means and standard deviations for vital signs, HRV, HRC, and Glasgow coma scale (GCS) scores were obtained for nonsurvivors versus survivors and LSI versus non-LSI patient groups and then compared using Wilcoxon statistical tests. Receiver-operating characteristic curves were also obtained to compare different regression models for predicting mortality and the need for LSIs. Seventeen patients (16%) died. Eighty-two patients (76%) received a total of 142 LSIs. Receiver-operating characteristic curves demonstrated better prediction of mortality and LSI needs using heart rate and HRC (area under the curve [AUC]; AUCs, 0.86 and 0.86) than using heart rate alone (AUCs, 0.79 and 0.57). Likewise, receiver-operating characteristic curves demonstrated better prediction using total GCS score and HRC (AUCs, 0.82 and 0.97) than using total GCS score (AUCs, 0.81 and 0.91). Similar results were obtained for heart rate and HRV (AUCs, 0.86 and 0.73). The major implication of this study was that traditional and new vital signs (HRV and HRC) should be used simultaneously to improve prediction of mortality and the need for LSIs in prehospital trauma patients during all echelons of trauma care. Improvements in the timely use and diagnostic accuracy of transportable vital signs monitors will require use of traditional and new vital signs from the trauma patient cohort.

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