title: Heart rate and systolic blood pressure in patients with minor to moderate, non-haemorrhagic injury versus normal controls.
abstract: BACKGROUND
  Raised blood pressure (and heart rate (HR)) due to anxiety in a clinical situation is well described and is called the white coat effect (WCE). It is not known whether the pain and anxiety that results from trauma causes a measurable WCE.
  
  
  METHODS
  A sample of patients with a non-haemorrhagic injury from the Trauma Audit and Research Network (TARN) was compared with a healthy, non-injury sample from the Health Survey for England (HSE) databases. Two-way analysis of variance with rank transformation of data was used to compare systolic blood pressure (SBP) and HR between the groups at different ages. In the injured group, the SBP and HR were also compared between spinally immobilised and non-immobilised patients.
  
  
  RESULTS
  There was a statistically significant difference between the groups for both HR and SBP (p<0.001). Median HR remained approximately 10 bpm higher in the TARN set when compared to the HSE set, irrespective of age. The difference for SBP was not considered clinically relevant (the highest was 5 mm Hg). There was no significant difference between immobilised and non-immobilised patients, for either HR or SBP (p=0.07 and 0.3, respectively).
  
  
  CONCLUSIONS
  Median HR remained approximately 10 bpm higher in the TARN (injury) set compared to the HSE (non-injury, control) set, irrespective of age. Understanding that HR reacts in this way for mild to moderately injured patients is important as it will affect clinical interpretation during the initial assessment.
authors.affiliation: Division of Emergency Medicine, University of Cape Town, , Cape Town, South Africa.
authors.forename: Stevan Raynier
authors.initials: SR
authors.lastname: Bruijns
authors.forename: Henry R
authors.initials: HR
authors.lastname: Guly
authors.forename: Omar
authors.initials: O
authors.lastname: Bouamra
authors.forename: Fiona
authors.initials: F
authors.lastname: Lecky
authors.forename: Lee A
authors.initials: LA
authors.lastname: Wallis
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001794:Blood Pressure / Q000502:physiology*; D016022:Case-Control Studies; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007103:Immobilization / Q000502:physiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013599:Systole / Q000502:physiology; D014947:Wounds and Injuries / Q000503:physiopathology*; D055815:Young Adult