American Journal of Emergency Medicine
Volume 21, Issue 1 , Pages 45-47, January 2003

Unique cutpoints for sitting-to-standing orthostatic vital signs☆☆☆

Presented at the 4th Annual Mid-Atlantic Regional Society for Academic Emergency Medicine Research Conference, Charlotte, NC. March 31, 2001.

Division of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD.

Received 25 March 2002; accepted 25 March 2002.

Abstract 

The study objective was to describe the distribution of normal changes in vital signs related to moving from a sitting to a standing position. Subjects were free of cardiovascular disease and determined to be euvolemic by structured interview. Vital signs were measured after a minimum of 5 minutes of sitting and after 1 minute of standing. Among 176 subjects, mean differences in parameters (± standard deviation) were as follows: pulse increase, 5.3 ± 6.6 beats per minute (bpm); systolic blood pressure (SBP) decrease, 1.2 ± 9.8 mmHg; and shock index (SI) increase, 0.05 ± 0.07 bpm/mmHg. These changes are less extreme than those previously published for changes from lying to standing. Unique tilt test positivity criteria and their expected specificities are as follows: pulse increase ≥20 bpm (0.98), SBP decrease ≥20 mmHg (0.97), SI increase ≥0.2 (0.99), ROSI ≥1.3 (0.95). Sitting-to-standing tilt tests require positivity criteria distinct from those published for lying-to-standing tilt tests. (Am J Emerg Med 2003;21:45-47. Copyright 2003, Elsevier Science (USA). All rights reserved.)

Keywords:  Pulse, blood pressure, dizziness, orthostatic hypotension, hypovolemia, syncope

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☆ Address reprint requests to Michael D. Witting, MD, Division of Emergency Medicine, University of Maryland School of Medicine, 419 W. Redwood Street, Suite 280, Baltimore, MD 21201. E-mail: mwitt001@umaryland.edu

☆☆ 0735-6757/03/2101-0010$35.00/0

PII: S0735-6757(02)42210-3

doi:10.1053/ajem.2003.50009

American Journal of Emergency Medicine
Volume 21, Issue 1 , Pages 45-47, January 2003

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