Variation in Orthostatic Vital Sign Testing in an Urban Academic Emergency Department

Abstract

Orthostatic vital signs are more sensitive than traditional vital signs in the detection of hypovolemia, and they are useful in the evaluation of dizziness and syncope. 1 McGee S Abernethy III, WB Simel DL The rational clinical examination: is this patient hypovolemic?. JAMA. 1999; 281: 1022-1029 Crossref PubMed Scopus (438) Google Scholar , 2 Kessler C Tristano JM De Lorenzo R The emergency department approach to syncope: evidence-based guidelines and prediction rules. Emerg Med Clin North Am. 2010; 28: 487-500 Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar A variety of procedures for measurement of orthostatic vital signs and criteria for a positive test have been proposed. 1 McGee S Abernethy III, WB Simel DL The rational clinical examination: is this patient hypovolemic?. JAMA. 1999; 281: 1022-1029 Crossref PubMed Scopus (438) Google Scholar , 3 Witting MD Gallagher K Unique cutpoints for sitting-to-standing orthostatic vital signs. Am J Emerg Med. 2003; 21: 45-47 Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar , 4 Baraff LJ Schriger DL Orthostatic vital signs: variation with age, specificity, and sensitivity in detecting a 450-mL blood loss. Am J Emerg Med. 1992; 10: 99-103 Abstract Full Text PDF PubMed Scopus (31) Google Scholar , 5 Knopp R Claypool R Leonardi D Use of the tilt test in measuring acute blood loss. Ann Emerg Med. 1980; 9: 72-75 Abstract Full Text PDF PubMed Scopus (59) Google Scholar , 6 Lance R Link ME Padua M et al. Comparison of different methods of obtaining orthostatic vital signs. Clin Nurs Res. 2000; 9: 479-491 Crossref PubMed Scopus (13) Google Scholar , 7 Skinner JE Driscoll SW Porter CB et al. Orthostatic heart rate and blood pressure in adolescents: reference ranges. J Child Neurol. 2010; 25: 1210-1215 Crossref PubMed Scopus (22) Google Scholar , 8 Gorgas DL Barry JD Vital signs measurement. in: Roberts JR Hedges JR Clinical Procedures in Emergency Medicine. 5th ed. Saunders, Philadelphia, PA2010: 1-21 Crossref Google Scholar Michael D. Witting is Associate Professor, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD. Stacey Chaney Hydorn, Member, Baltimore Metro Chapter of ENA, is Senior Clinical Nurse I, University of Maryland Medical Center, Baltimore, MD.