orthostatic vital signs in the ED: not so 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) and 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

--also seen:

• >20 increased HR

NOT TOO USEFUL:

--study of 132 random, presumed euvolemic ED patients

--took lying & standing vitals

--HR range was from decreases 5.0 to increases 39.4 beats per minute

--SBP range was decreases 20 to increases 25.7 mm Hg

--DBP range was decreases 6.4 to increases 24.9 mm Hg

--43% had "positive" orthostatic vital signs according to currently accepted values

TO REITERATE:

--43% of likely euvolemic random ED patients had +orthostatic vitals by numbers

--43% suspected false positive, essentially

--probably not a useful test, this orthostatic vital signs thing

  

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