Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Suite 8215N, Los Angeles, CA 90048, USA.
J Trauma Acute Care Surg. 2012 Apr;72(4):943-7. doi: 10.1097/TA.0b013e3182465527.
The association between admission heart rate (AHR) and mortality after trauma can assist initial emergency department triage and resuscitation. In addition, increased AHR is often associated with sympathetic hyperactivity which may require targeted treatment. We determined whether AHR was a predictor for mortality in trauma patients.
The Los Angeles County Trauma System Database was queried for all injured patients admitted between 1998 and 2005 (n = 147,788). Traumatic brain injury (TBI) patients (head Abbreviated Injury Scale score ≥ 3) were excluded. Demographics were compared at various AHR subgroups (<50, 50-59, 60-69, 70-79, 80-89, 90-99, 100-109, and ≥ 110). Mortality was compared at various AHR ranges, and logistic regression was performed to determine significance.
After exclusions, 103,799 trauma patients requiring admission were identified; overall mortality was 1.4%. AHR 80 to 89 demonstrated a statistically significant lower mortality (0.5%) compared with all other AHR ranges, except AHR 70 to 79 (0.6%). In trauma patients who required admission, AHR 70 to 79 and 80 to 89 were predictors of lower mortality. Mortality for 22,232 moderate to severely injured patients was 5.5% and AHR 80 to 89 demonstrated a statistically lower mortality (2.0%) than all other AHR ranges, except AHR 70 to 79 (1.9%). After moderate to severe trauma, AHR <60 and ≥ 100 were associated with significantly higher mortality.
Mortality after trauma increases outside the AHR range of 70 to 89 beats per minute. AHR ranges previously considered "normal" were associated with significantly increased mortality. Prospective research is required to evaluate if resuscitation goals should target heart rate at the 70 to 89 range.
入院时的心率（AHR）与创伤后死亡率之间存在关联，可辅助初始急诊科分诊和复苏。此外，AHR 升高通常与交感神经兴奋有关，可能需要针对性治疗。我们确定 AHR 是否是创伤患者死亡的预测因素。
检索 1998 年至 2005 年期间洛杉矶县创伤系统数据库中所有入院的受伤患者（n=147788）。排除创伤性脑损伤（TBI）患者（头部损伤严重程度量表评分≥3）。在不同 AHR 亚组（<50、50-59、60-69、70-79、80-89、90-99、100-109 和≥110）比较人口统计学特征。在不同 AHR 范围内比较死亡率，并进行 logistic 回归分析以确定显著性。
排除后，确定了 103799 名需要入院的创伤患者；总体死亡率为 1.4%。AHR 80-89 与其他所有 AHR 范围相比，死亡率（0.5%）具有统计学显著降低，除 AHR 70-79（0.6%）外。在需要入院的创伤患者中，AHR 70-79 和 80-89 是死亡率降低的预测因素。22232 名中度至重度受伤患者的死亡率为 5.5%，AHR 80-89 与其他所有 AHR 范围（除 AHR 70-79 外，死亡率为 1.9%）相比，死亡率统计学上较低。在中度至重度创伤后，AHR<60 和≥100 与死亡率显著升高相关。
创伤后死亡率在 AHR 70-89 次/分范围之外增加。之前被认为“正常”的 AHR 范围与显著增加的死亡率相关。需要前瞻性研究评估复苏目标是否应将心率定在 70-89 次/分范围内。
