title: Heart rate in pediatric trauma: rethink your strategy.
abstract: BACKGROUND
  The optimal heart rate (HR) for children after trauma is based on values derived at rest for a given age. As the stages of shock are based in part on HR, a better understanding of how HR varies after trauma is necessary. Admission HRs of pediatric trauma patients were analyzed to determine which ranges were associated with lowest mortality.
  
  
  METHODS
  The National Trauma Data Bank was used to evaluate all injured patients ages 1-14 years admitted between 2007 and 2011. Patients were stratified into eight groups based on age. Clinical characteristics and outcomes were recorded, and regression analysis was used to determine mortality odds ratios (ORs) for HR ranges within each age group.
  
  
  RESULTS
  A total of 214,254 pediatric trauma patients met inclusion criteria. The average admission HR and systolic blood pressure were 104.7 and 120.4, respectively. Overall mortality was 0.8%. The HR range associated with lowest mortality varied across age groups and, in children ages 7-14, was narrower than accepted resting HR ranges. The lowest risk of mortality for patients ages 5-14 was captured at HR 80-99.
  
  
  CONCLUSIONS
  The HR associated with lowest mortality after pediatric trauma frequently differs from resting HR. Our data suggest that a 7y old with an HR of 115 bpm may be in stage III shock, whereas traditional HR ranges suggest that this is a normal rate for this child. Knowing when HR is critically high or low in the pediatric trauma population will better guide treatment.
authors.affiliation: Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Ara
authors.initials: A
authors.lastname: Ko
authors.affiliation: Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Megan Y
authors.initials: MY
authors.lastname: Harada
authors.affiliation: Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Jason S
authors.initials: JS
authors.lastname: Murry
authors.affiliation: Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Miriam
authors.initials: M
authors.lastname: Nuño
authors.affiliation: Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Galinos
authors.initials: G
authors.lastname: Barmparas
authors.affiliation: Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Annie A
authors.initials: AA
authors.lastname: Ma
authors.affiliation: Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Gretchen M
authors.initials: GM
authors.lastname: Thomsen
authors.affiliation: Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California. Electronic address: Eric.Ley@cshs.org.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Ley
mesh_terms: D000293:Adolescent; D002140:California / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006339:Heart Rate; D006801:Humans; D007223:Infant; D008297:Male; D010372:Pediatrics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000401:mortality* / Q000503:physiopathology
keywords: Heart rate; Mortality; Pediatric trauma; Pediatric vitals