orthostatic vital signs in the ED

6 Nov

revisiting an old topic, but useful (in that it tells us a test is not that useful)

THEORY:

normally, standing leads to 

  • a small fall in systolic BP (5 to 10 mmHg),
  • an increase in diastolic BP (5 to 10 mmHg)
  • a compensatory increase in pulse rate (10 to 25 beats per minute)

 

traditional criteria for orthostatic hypotension

  • > 20 mmHg decreased SBP
  • > 10 mmHg decreased DBP
  • Symptoms of cerebral hypoperfusion
  • >20 increased HR

 

WHAT HAPPENS WHEN YOU TEST REGULAR PEOPLE?

study of 132 random, presumed euvolemic ED patients, took lying & standing vitals

  • HR range was from -5.0 to +39.4 beats per minute
  • SBP range was -20 to +25.7 mm Hg
  • DBP range was -6.4 to +24.9 mm Hg

43% had “positive” orthostatic vital signs according to currently accepted values

 

BOTTOM LINE:

43% non-hypovolemic patients had “positive” orthostatic vital signs

orthostatic vital signs: probably not a useful test

  

Reference(s): uptodate.com: Mechanisms, causes, and evaluation of orthostatic and postprandial hypotension; study from 1991, picture

Advertisements

One Response to “orthostatic vital signs in the ED”

Trackbacks/Pingbacks

  1. orthostatic vital signs in blood donors | DAILYEM - April 8, 2014

    […] minute +/- diastolic blood pressure fall >10mm Hg had high specificity but poor sensitivity.   Head back to this old post for some more on the (lack of) utility of orthostatic vital signs in the ….   References: blood donor article; […]

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: