title: Volatility: a new vital sign identified using a novel bedside monitoring strategy.
abstract: BACKGROUND
  SIMON (Signal Interpretation and Monitoring) monitors and archives continuous physiologic data in the ICU (HR, BP, CPP, ICP, CI, EDVI, SVO2, SPO2, SVRI, PAP, and CVP). We hypothesized: heart rate (HR) volatility predicts outcome better than measures of central tendency (mean and median).
  
  
  METHODS
  More than 600 million physiologic data points were archived from 923 patients over 2 years in a level one trauma center. Data were collected every 1 to 4 seconds, stored in a MS-SQL 7.0 relational database, linked to TRACS, and de-identified. Age, gender, race, Injury Severity Score (ISS), and HR statistics were analyzed with respect to outcome (death and ventilator days) using logistic and Poisson regression.
  
  
  RESULTS
  We analyzed 85 million HR data points, which represent more than 71,000 hours of continuous data capture. Mean HR varied by age, gender and ISS, but did not correlate with death or ventilator days. Measures of volatility (SD, % HR >120) correlated with death and prolonged ventilation.
  
  
  CONCLUSIONS
  1) Volatility predicts death better than measures of central tendency. 2) Volatility is a new vital sign that we will apply to other physiologic parameters, and that can only be fully explored using techniques of dense data capture like SIMON. 3) Densely sampled aggregated physiologic data may identify sub-groups of patients requiring new treatment strategies.
authors.affiliation: VA Quality Scholars Program, Vanderbilt University Department of Surgery, Nashville, Tennessee, USA.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Grogan
authors.forename: Patrick R
authors.initials: PR
authors.lastname: Norris
authors.forename: Theodore
authors.initials: T
authors.lastname: Speroff
authors.forename: Asli
authors.initials: A
authors.lastname: Ozdas
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: France
authors.forename: Paul A
authors.initials: PA
authors.lastname: Harris
authors.forename: Judith M
authors.initials: JM
authors.lastname: Jenkins
authors.forename: Renee
authors.initials: R
authors.lastname: Stiles
authors.forename: Robert S
authors.initials: RS
authors.lastname: Dittus
authors.forename: John A
authors.initials: JA
authors.lastname: Morris
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008991:Monitoring, Physiologic; D019095:Point-of-Care Systems; D016012:Poisson Distribution; D011237:Predictive Value of Tests; D012042:Registries; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000401:mortality*