Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 1/2021

01-02-2021 | Polytrauma | Original Article

Spectral analysis of heart rate variability for trauma outcome prediction: an analysis of 210 ICU multiple trauma patients

Authors: Xiaomin Luo, Haijun Gao, Xingxia Yu, Zongping Jiang, Weize Yang

Published in: European Journal of Trauma and Emergency Surgery | Issue 1/2021

Login to get access

Abstract

Purpose

This study aimed to test and compare short-term spectral HRV indices with most used trauma scorings in outcome prediction of multiple trauma, and then to explore the efficacy of their combined application.

Methods

A prospective study was conducted for patients with blunt multiple trauma admitted to an emergency intensive care unit (ICU) between January 2016 and December 2017. Short-term spectral HRV indices on admission were measured, including normalized low-frequency power (nLF), normalized high-frequency power (nHF), and the nLF/nHF ratio. Injury severity score (ISS), new injury severity score (NISS), and revised trauma score (RTS) were evaluated for each patient, as well as probability of survival (Ps) by trauma and injury severity score (TRISS) model. The primary outcome was 30-day mortality and secondary outcomes were incidence of multiple organ dysfunction syndrome (MODS) and length of ICU stay.

Results

Two hundred and ten patients were recruited. The nLF/nHF ratio, RTS, and Ps(TRISS) were independent predictors of 30-day mortality, while nLF/nHF, NISS and RTS were independent predictors of MODS. The area under the receiver operating characteristic (ROC) curve (AUC) of nLF/nHF for 30-day mortality prediction was 0.924, comparable to RTS (0.951) and Ps(TRISS) (0.892). AUC of nLF/nHF-RTS combination was 0.979, significantly greater than that of each alone. Combination of nLF/nHF and Ps(TRISS) showed an increased AUC (0.984) compared to each of them. The nLF/nHF ratio presented a similar AUC (0.826) to NISS (0.818) or RTS (0.850) for MODS prediction. AUC of nLF/nHF-RTS combination was 0.884, significantly greater than that of nLF/nHF. Combination of nLF/nHF and NISS showed a greater AUC (0.868) than each alone. The nLF/nHF ratio, NISS, RTS, and Ps(TRISS) were correlated with length of ICU stay for survivors, with correlation coefficients 0.476, 0.617, − 0.588, and − 0.539.

Conclusions

These findings suggest that the short-term spectral analysis of HRV might be a potential early tool to assess injury severity and predict outcome of multiple trauma. Combination of nLF/nHF and conventional trauma scores can provide more accuracy in outcome prediction of multiple trauma.
Literature
1.
2.
Karakus A, Kekec Z, Akcan R, Seydaoglu G. The relationship of trauma severity and mortality with cardiac enzymes and cytokines at multiple trauma patients. Ulus Travma Acil Cerrahi Derg. 2012;18(4):289–95.CrossRef
3.
Butcher NE, Balogh ZJ. Update on the definition of polytrauma. Eur J Trauma Emerg Surg. 2014;40(2):107–11.CrossRef
4.
Smith BP, Goldberg AJ, Gaughan JP, Seamon MJ. A comparison of Injury Severity Score and New Injury Severity Score after penetrating trauma: a prospective analysis. J Trauma Acute Care Surg. 2015;79(2):269–74.CrossRef
5.
Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187–96.CrossRef
6.
Osler T, Baker SP, Long W. A modification of the injury severity score that both improves accuracy and simplifies scoring. J Trauma. 1997;143(6):922–5.CrossRef
7.
Eid HO, Abu-Zidan FM. New injury severity score is a better predictor of mortality for blunt trauma patients than the injury severity score. World J Surg. 2015;39(1):165–71.CrossRef
8.
Tohira H, Jacobs I, Mountain D, Gibson N, Yeo A. Systematic review of predictive performance of injury severity scoring tools. Scand J Trauma Resusc Emerg Med. 2012;20:63.CrossRef
9.
Wong TH, Krishnaswamy G, Nadkarni NV, Nguyen HV, Lim GH, Bautista DC, et al. Combining the new injury severity score with an anatomical polytrauma injury variable predicts mortality better than the new injury severity score and the injury severity score: a retrospective cohort study. Scand J Trauma Resusc Emerg Med. 2016;24:25.CrossRef
10.
Jeong JH, Park YJ, Kim DH, Kim TY, Kang C, Lee SH, et al. The new trauma score (NTS): a modification of the revised trauma score for better trauma mortality prediction. BMC Surg. 2017;17(1):77.CrossRef
11.
Manoochehry S, Vafabin M, Bitaraf S, Amiri A. A Comparison between the ability of revised trauma score and kampala trauma score in predicting mortality; a meta-analysis. Arch Acad Emerg Med. 2019;7(1):e6.PubMedPubMedCentral
12.
Champion HR, Sacco WJ, Hunt TK. Trauma severity scoring to predict mortality. World J Surg. 1983;7:4–11.CrossRef
13.
Moore L, Lavoie A, Turgeon AF, Abdous B, Le Sage N, Emond M, et al. Improving trauma mortality prediction modeling for blunt trauma. J Trauma. 2010;68:698–705.CrossRef
14.
Offner PJ, Jurkovich GJ, Gurney J, Rivara FP. Revision of TRISS for intubated patients. J Trauma. 1992;32:32–5.CrossRef
15.
Raux M, Thicoïpé M, Wiel E, Rancurel E, Savary D, David JS, et al. Comparison of respiratory rate and peripheral oxygen saturation to assess severity in trauma patients. Intensive Care Med. 2006;32:405–12.CrossRef
16.
Schluter PJ. Trauma and injury severity score (TRISS): is it time for variable re-categorisations and re-characterisations? Injury. 2011;42:83–9.CrossRef
17.
Mazzeo AT, La Monaca E, Di Leo R, Vita G, Santamaria LB. Heart rate variability: a diagnostic and prognostic tool in anesthesia and intensive care. Acta Anaesthesiol Scand. 2011;55(7):797–811.CrossRef
18.
Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task force of the european society of cardiology and the north american society of pacing and electrophysiology. Circulation. 1996; 93(5):1043–1065.
19.
Liu NT, Holcomb JB, Wade CE, Salinas J. Improving the prediction of mortality and the need for life-saving interventions in trauma patients using standard vital signs with heart-rate variability and complexity. Shock. 2015;43(6):549–55.CrossRef
20.
Norris PR, Morris JA Jr, Ozdas A, Grogan EL, Williams AE. Heart rate variability predicts trauma patient outcome as early as 12 h: implications for military and civilian triage. J Surg Res. 2005;129(1):122–8.CrossRef
21.
Pontet J, Contreras P, Curbelo A, Medina J, Noveri S, Bentancourt S, et al. Heart rate variability as early marker of multiple organ dysfunction syndrome in septic patients. J Crit Care. 2003;18(3):156–63.CrossRef
22.
Scantling D, Teichman A, Kucejko R, McCracken B, Eakins J, Burns R. Identifying preventable trauma death: does autopsy serve a role in the peer review process? J Surg Res. 2017;215:140–5.CrossRef
23.
Shepherd JM, Cole E, Brohi K. Contemporary patterns of multiple organ dysfunction in trauma. Shock. 2017;47(4):429–35.CrossRef
24.
Fong SS, Wong JY, Chung LM, Yam TT, Chung JW, Lee YM, et al. Changes in heart-rate variability of survivors of nasopharyngeal cancer during Tai Chi Qigong practice. J Phys Ther Sci. 2015;27(5):1577–9.CrossRef
25.
Saito I, Maruyama K, Eguchi E, Kato T, Kawamura R, Takata Y, et al. Low heart rate variability and sympathetic dominance modifies the association between insulin resistance and metabolic syndrome—The toon health study. Circ J. 2017;81(10):1447–53.CrossRef
26.
Koko KR, McCauley BD, Gaughan JP, Fromer MW, Nolan RS, Hagaman AL, et al. Spectral analysis of heart rate variability predicts mortality and instability from vascular injury. J Surg Res. 2018;224:64–71.CrossRef
27.
Ryan ML, Ogilvie MP, Pereira BM, Gomez-Rodriguez JC, Manning RJ. Heart rate variability is an independent predictor of morbidity and mortality in hemodynamically stable trauma patients. J Trauma. 2011;70(6):1371–80.CrossRef
28.
Loguidice MJ, Schutt RC, Horton JW, Minei JP, Keeley EC. Heart rate variability as a predictor of death in burn patients. J Burn Care Res. 2016;37(3):e227–33.CrossRef
29.
Morris JA Jr, Norris PR, Moore JH, Jenkins JM, Williams AE, Canter JA. Genetic variation in the autonomic nervous system affects mortality: a study of 1,095 trauma patients. J Am Coll Surg. 2009;208(5):663–8.CrossRef
30.
Minei JP, Cuschieri J, Sperry J, Moore EE, West MA, Harbrecht BG, et al. The changing pattern and implications of multiple organ failure after blunt injury with hemorrhagic shock. Crit Care Med. 2012;40(4):1129–35.CrossRef
31.
Xu L, Yu WK, Lin ZL, Tan SJ, Bai XW, Ding K, et al. Chemical sympathectomy attenuates inflammation, glycocalyx shedding and coagulation disorders in rats with acute traumatic coagulopathy. Blood Coagul Fibrinolysis. 2015;26(2):152–60.CrossRef
32.
Xu L, Yu WK, Lin ZL, Tan SJ, Bai XW, Ding K, et al. Impact of β adrenoceptor blockade on systemic inflammation and coagulation disturbances in rats with acute traumatic coagulopathy. Med Sci Monit. 2015;21:468–76.CrossRef
33.
Schmidt H, Lotze U, Ghanem A, Anker SD, Said SM, Braun-Dullaeus R, et al. Relation of impaired interorgan communication and parasympathetic activity in chronic heart failure and multiple-organ dysfunction syndrome. J Crit Care. 2014;29(3):367–73.CrossRef
34.
Borovikova LV, Ivanova S, Zhang M, Yang H, Botchkina GI, Watkins LR, et al. Vagus nerve stimulation attenuates the systemic inflammatory response to endotoxin. Nature. 2000;405(6785):458–62.CrossRef
35.
Zhai Q, Lai D, Cui P, Zhou R, Chen Q, Hou J, et al. Selective activation of basal forebrain cholinergic neurons attenuates polymicrobial sepsis-induced inflammation via the cholinergic anti-Inflammatory pathway. Crit Care Med. 2017;45(10):e1075–82.CrossRef
36.
Werdan K, Schmidt H, Ebelt H, Zorn-Pauly K, Koidl B, Hoke RS, et al. Impaired regulation of cardiac function in sepsis, SIRS, and MODS. Can J Physiol Pharmacol. 2009;87(4):266–74.CrossRef
37.
Biering-Sørensen F, Biering-Sørensen T, Liu N, Malmqvist L, Wecht JM, Krassioukov A. Alterations in cardiac autonomic control in spinal cord injury. Auton Neurosci. 2018;209:4–18.CrossRef
38.
Biswas AK, Scott WA, Sommerauer JF, Luckett PM. Heart rate variability after acute traumatic brain injury in children. Crit Care Med. 2000;28(12):3907–12.CrossRef
39.
Kox M, Vrouwenvelder MQ, Pompe JC, van der Hoeven JG, Pickkers P, Hoedemaekers CW. The effects of brain injury on heart rate variability and the innate immune response in critically ill patients. J Neurotrauma. 2012;29(5):747–55.CrossRef
Metadata
Title
Spectral analysis of heart rate variability for trauma outcome prediction: an analysis of 210 ICU multiple trauma patients
Authors
Xiaomin Luo
Haijun Gao
Xingxia Yu
Zongping Jiang
Weize Yang
Publication date
01-02-2021
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 1/2021
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-019-01175-5

Other articles of this Issue 1/2021

European Journal of Trauma and Emergency Surgery 1/2021 Go to the issue

Review Article

A contemporary assessment of devices for Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA): resource-specific options per level of care

Letter to the Editor

CRASH 3: a monumental effort with minimal gain

Original Article

Is there a correlation between fragility fractures of the pelvis (FFP) and the morphology of the true pelvis in geriatric patients?

Review Article

May the initial CT scan predict the occurrence of delayed hemothorax in blunt chest trauma patients?

Correction

Correction to: Effect of fracturoscopy on the incidence of surgical site infections post tibial plateau fracture surgery

Original Article

What effect has the major trauma network had on perceptions of trauma care delivery amongst trauma teams in major trauma centres and neighbouring trauma units?