Emerg Med J doi:10.1136/emermed-2012-201760
  • Original article

Heart rate and systolic blood pressure in patients with minor to moderate, non-haemorrhagic injury versus normal controls

  1. Lee A Wallis1
  1. 1Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
  2. 2Department of Emergency Medicine, Derriford Hospital, Plymouth, UK
  3. 3Trauma Audit Research Network, Manchester Medical Academic Health Sciences Centre, University of Manchester, Salford Royal NHS Foundation Trust, Salford, UK
  1. Correspondence to Dr Stevan Raynier Bruijns, Division of Emergency Medicine, University of Cape Town, Karl Bremer Hospital, Mike Pienaar Blvd, Bellville, 7535, South Africa; stevan.bruijns{at}
  • Accepted 22 October 2012
  • Published Online First 26 November 2012


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).

Discussion 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.

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Among patients with minor TBI (GCS 13-15) getting CT scans ≥ 24 hours after injury, what proportion have a traumatic finding?


0.5% - 43% response rate
3% - 41% response rate
10% - 16% response rate

Related original article: PCT head imaging in patients with head injury who present after 24 h of injury: a retrospective cohort study

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