title: Reevaluating the association between emergency department heart rate and the development of posttraumatic stress disorder: A public health approach.
abstract: BACKGROUND
  Preliminary investigations in select samples of trauma survivors presenting to acute care settings suggest an association between elevated emergency department heart rate (HR) and the subsequent development of posttraumatic stress disorder (PTSD). Other studies suggest no association, however.
  
  
  METHODS
  In a prospective cohort study of a population-based sample of 161 acutely injured surgical inpatients, HR was assessed at initial presentation to the emergency department. Symptoms of PTSD were assessed with the PTSD Checklist at the time of the surgical inpatient hospitalization and 1, 4-6, and 12 months postinjury.
  
  
  RESULTS
  Emergency department HR > or = 95 beats per minute (BPM) was a significant independent predictor of PTSD symptoms in analyses that adjusted for relevant injury, clinical, and demographic characteristics. This HR cutoff demonstrated modest specificity (range 60%-65%) and sensitivity (range 49%-63%) for the prediction of chronic PTSD.
  
  
  CONCLUSIONS
  We found an independent association between elevated emergency department HR > or = 95 BPM and PTSD symptoms in a representative sample of injured acute care inpatients. Future investigations that incorporate clinical epidemiologic methods in the study of acute care biological parameters have the potential to improve the quality of mental health care delivered to injured survivors of individual and mass trauma.
authors.affiliation: Department of Psychiatry, Harborview Medical Center, University of Washington School of Medicine, Box 359911, HMC, 325 Ninth Avenue, Seattle, WA 98104, USA. dzatzick@u.washington.edu
authors.forename: Douglas F
authors.initials: DF
authors.lastname: Zatzick
authors.forename: Joan
authors.initials: J
authors.lastname: Russo
authors.forename: Roger K
authors.initials: RK
authors.lastname: Pitman
authors.forename: Frederick
authors.initials: F
authors.lastname: Rivara
authors.forename: Gregory
authors.initials: G
authors.lastname: Jurkovich
authors.forename: Peter
authors.initials: P
authors.lastname: Roy-Byrne
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D003710:Demography; D004632:Emergency Medical Services; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011634:Public Health / Q000379:methods*; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000503:physiopathology*; D013997:Time Factors