Defining the Positive Tilt Test: A Study of Healthy Adults With Moderate Acute Blood Loss

Witting, Michael D.; Wears, Robert L.; Sergio, Li

doi:10.1016/s0196-0644(94)70358-2

Cited by 23 publications

(10 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our results suggest that this method may also be useful in detecting significant changes in tissue interstitial fluid under conditions of mild dehydration. This plasma volume loss of *10% for the patients in this study is comparable to the 450 mL blood loss used in other EDbased studies where orthostatic vital signs were found to be insufficient measures for the detection of fluid losses [2]. Since the technique obtains measurements in the supine position, it also obviates the potential of creating orthostatic symptoms in the ED environment.…”

Section: Discussionsupporting

confidence: 63%

“…Traditional ED methods for determining the hydration status of patients have been shown to have significant limitations in specificity and sensitivity [2][3][4]. Commonly used methods, such as orthostatic tilt testing, are often unable to differentiate conditions of mild dehydration and may be unnecessary or impractical in patients with severe Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Traditional hallmark findings on clinical examination such as the capillary refill are not always predictive of the patient's state of hydration [1]. Likewise, commonly used techniques that observe changes in heart rate and blood pressure during emergency department (ED) orthostatic testing have been found to be highly variable and lack the sensitivity and specificity to be clinically dependable [2,3]. Even an optimized tilt test has shown limited utility in detecting mild to moderate intravascular fluid loss (\10%) [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Ultrasound measurements of lower extremity soft tissue and interstitial fluid thickness may be used as an early indicator of dehydration

et al. 2010

View full text Add to dashboard Cite

Purpose Several studies have suggested that clinical indicators of a patient's fluid status that are frequently used in practice are highly variable and not useful in the differentiation of these patients. In this study, we examine the potential use of ultrasound measurements of soft tissue and interstitial fluid thickness for the detection of conditions of mild to moderate dehydration. Materials and methods This study involved healthy subjects in which a mild dehydration was a consequence of tilt bed rest (average loss of plasma volume of *10%). The soft tissue and interstitial thickness superficial to the calcaneous and immediately below the lateral malleolus were measured in the supine position using high frequency ultrasound both before and after the treatment. Also the echocardiographic measurements of orthostatic induced changes in stroke volume were obtained. Results In the eight healthy subjects studied, there was an average of a 13% diminution in both the ankle and pretibial soft tissue and interstitial thickness after tilt bed rest (p = 0.05) that coincided with mildly decreased orthostatic induced changes in stroke volume. Conclusions Traditional tilt testing has been a less than satisfactory technique for determining the hydration status of patients. This study looks at the possibility of using ultrasound as a method for the objective measurement of tissue dehydration. The method was able to detect significant changes in tissue interstitial fluid under conditions of mild dehydration. Since the technique obtains measurements in the supine position, it also obviates creating orthostatic symptoms in restrictive clinical environments.

show abstract

Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Ultrasound measurements of lower extremity soft tissue and interstitial fluid thickness may be used as an early indicator of dehydration

et al. 2010

View full text Add to dashboard Cite

show abstract

“…Early ED studies focused on whether OVS could be used to reliably diagnose hypovolemia, and measured both HR and BP responses to posture change . These studies are of questionable relevance to older adults, as they enrolled predominantly young subjects with mild hypovolemia and excluded individuals on antihypertensive medications . Additionally, in older adults there is a strong negative correlation between age and any orthostatic HR change .…”

Section: Orthostatic Vital Sign Measurementmentioning

confidence: 99%

Reconsidering orthostatic vital signs in older emergency department patients

Kennedy

Davenport

Liu

et al. 2018

Emerg Medicine Australasia

View full text Add to dashboard Cite

“…There are several published cri-teria for a positive tilt test combining changes in pulse and blood pressure (BP)?-' but their overall sensitivities in detecting moderate acute blood loss (mean 9% of estimated blood volume) range from only 15% to 47%. 6 Hence, clinicians should not rely on these tests to rule out moderate acute intravascular hypovolemia.…”

mentioning

confidence: 99%

Orthostatic Change in Shock Index: Comparison with Traditional Tilt Test Definitions

Witting¹,

Smithline²

1996

Academic Emergency Medicine

View full text Add to dashboard Cite

Objective: To determine whether the orthostatic change in the shock index or published tilt test criteria better discriminated normal individuals from those with moderate acute blood loss. Methods: Postural vital signs were recorded in a standardized manner before and after an elective 450‐mL phlebotomy associated with blood donation in healthy volunteers. Paired comparisons of the sensitivity of each of 3 published tilt test criteria were made against the sensitivity of an orthostatic change in shock index (OCSI) at the threshold for OCSI yielding the same specificity. Subjects were prospectively divided into group 1 (age < 65 years) and group 2 (age ≥ 65 years). Results: A total of 336 healthy euvolemic adult blood donors were studied over a 1‐year period (group 1 = 292; group 2 = 44). For each published criterion for a positive tilt test (for both groups), OCSI had the same or higher sensitivity for a chosen specificity. No sensitivity difference was statistically significant. An OCSI ≥ 0 was 99%/98% sensitive and 10%/10% specific (group l/group 2) for a 450‐mL blood loss; whereas an OCSI 2 0.25 was 28%/23% sensitive and 92%/100% specific (group l/group 2). Conclusion: The OCSI discriminates normal individuals from those with acute moderate blood loss as well as previously published tilt test definitions do.

show abstract

Defining the Positive Tilt Test: A Study of Healthy Adults With Moderate Acute Blood Loss

Cited by 23 publications

References 6 publications

Ultrasound measurements of lower extremity soft tissue and interstitial fluid thickness may be used as an early indicator of dehydration

Ultrasound measurements of lower extremity soft tissue and interstitial fluid thickness may be used as an early indicator of dehydration

Reconsidering orthostatic vital signs in older emergency department patients

Orthostatic Change in Shock Index: Comparison with Traditional Tilt Test Definitions

Contact Info

Product

Resources

About