Faculty Collaboration Database

Real-time heart rate entropy predicts the need for lifesaving interventions in trauma activation patients. J Trauma Acute Care Surg 2013 Oct;75(4):607-12

Date

09/26/2013

Pubmed ID

24064873

DOI

10.1097/TA.0b013e31829bb991

Scopus ID

2-s2.0-84885367170 (requires institutional sign-in at Scopus site)   11 Citations

Abstract

BACKGROUND: Heart rate complexity (HRC), commonly described as a "new vital sign," has shown promise in predicting injury severity, but its use in clinical practice has been precluded by the absence of real-time data. This study was conducted to evaluate the utility of real-time, automated, instantaneous, hand-held heart rate entropy analysis in predicting the need for lifesaving interventions (LSIs). We hypothesized that real-time HRC would predict LSIs.

METHODS: Prospective enrollment of patients who met criteria for trauma team activation was conducted at a Level I trauma center (September 2011 to February 2012). A novel, hand-held, portable device was used to measure HRC (by sample entropy) and time-domain heart rate variability continuously in real time for 2 hours after the moment of presentation. Electric impedance cardiography was used to determine cardiac output. Patients who received an LSI were compared with patients without any intervention (non-LSI). Multivariable analysis was performed to control for differences between the groups.

RESULTS: Of 82 patients enrolled, 21 (26%) received 67 LSIs within 24 hours of hospital arrival. Initial systolic blood pressure was similar in both groups. LSI patients had a lower Glasgow Coma Scale (GCS) score (9.2 [5.1] vs. 14.9 [0.2], p < 0.0001). The mean (SD) HRC value on presentation was 0.8 (0.6) in the LSI group compared with 1.5 (0.6) in the non-LSI group (p < 0.0001). With the use of logistic regression, initial HRC was the only significant predictor of LSI. A cutoff value for HRC of 1.1 yields sensitivity, specificity, negative predictive value, and positive predictive value of 86%, 74%, 94%, and 53%, respectively, with an accuracy of 77% for predicting an LSI.

CONCLUSION: Decreased HRC on hospital arrival is an independent predictor of the need for LSI in trauma activation patients. Real-time HRC may be a useful adjunct to standard vital signs monitoring and predicts LSIs.

LEVEL OF EVIDENCE: Prognostic and diagnostic study, level III.

Author List

Mejaddam AY, Birkhan OA, Sideris AC, Van der Wilden GM, Imam AM, Hwabejire JO, Chang Y, Velmahos GC, Fagenholz PJ, Yeh DD, de Moya MA, King DR

Author

Marc Anthony De Moya MD Chief, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Advanced Cardiac Life Support
Cardiac Output
Female
Glasgow Coma Scale
Heart Rate
Humans
Injury Severity Score
Logistic Models
Male
Multivariate Analysis
Prospective Studies
Sensitivity and Specificity
Wounds and Injuries