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WHEN AND HOW TO USE ORTHOSTATIC VITAL SIGNS

  • Michael D. Witting
    Correspondence
    Reprint Address: Michael D. Witting, MD, MS, University of Maryland Emergency Medicine Associates, 110 S. Paca St., 6th Floor, Baltimore, MD 21201.
    Affiliations
    Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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Published:September 16, 2022DOI:https://doi.org/10.1016/j.jemermed.2022.09.007

      Abstract

      Background

      Much controversy surrounds the use of orthostatic vital signs (OVS), including their indications, performance, and interpretation. This can lead to conflict between nurses, physicians, and consultants. This article summarizes the evidence for OVS in selected emergency department (ED) indications and the basis for a rapid measurement protocol.

      Objective

      This narrative review is intended to clarify indications for OVS measurement, their performance, and interpretation.

      Discussion

      Phlebotomy studies indicate that OVS are more discriminating than supine vital signs in hypovolemia, but many findings, even some considered “positive,” do not provide compelling evidence in favor of or against disease. Evaluated as a diagnostic test, they have a low yield and controversial criteria for a positive test, but as vital signs, they are useful for selected patients with frequent ED presentations—blood loss, dehydration, dizziness, weakness, and falls. Available evidence supports a rapid measurement protocol, including a 1-min interval after standing.

      Conclusion

      OVS are useful in selected patients, in a variety of frequent presentations, but their indications and implications for a patient's care are subject to physician interpretation. Given their ease of measurement and effect on decision-making, physicians may consider measuring them early in the evaluation of selected patients.

      Keywords

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