Abstract
The four classic vital signs are respiratory rate, temperature, pulse rate and blood pressure. Although their measurement has been standard practice for over a century, there have been few attempts to quantify their clinical performance. Until recently, the largest study of respiratory rate was performed by Hutchinson in 1846 and the largest studies on fever remain those performed by Wunderlich in the nineteenth century.
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References
Hutchinson J. On the capacity of the lungs, and on the respiratory functions with a view to establishing a precise and easy method of detecting disease by the spirometer. Med Chir Trans. 1846;29:137–252.
Mackowiak PA, Wasserman SS, Levine MM. A critical appraisal of 98.6°F, the upper limit of the normal body temperature and other legacies of Carl Reinhold August Wunderlich. JAMA. 1992;268(12):1578–1580.
Subbe CP, Kruger M, Rutherford P, Gemmel L. Validation of a modified early warning score in medical admissions. QJM. 2001;94(10):521–526.
Duckitt RW, Buxton-Thomas R, Walker J, et al. Worthing physiological scoring system: derivation and validation of a physiological early-warning system for medical admissions. An observational, population-based single-centre study. Br J Anaesth. 2007;98(6):769–774.
Jones AE, Yiannibas V, Johnson C, Kline J. Emergency department hypotension predicts sudden unexpected in-hospital mortality. Chest. 2006;130(4):941–946.
Allgower M, Buri C. Shock index. Dtsch Med Wochenschr. 1967;46:1–10.
Mower WR, Myers G, Nicklin EL, Kearin KT, Baraff LJ, Sachs C. Pulse oximetry as a fifth vital sign in emergency geriatric assessment. Acad Emerg Med. 1998;5(9):858–865.
Neff T. Routine oximetry. A fifth vital sign? Chest. 1988;94(2):227.
Flaherty JH, Rudolph J, Shay K, et al. Delirium is a serious and under-recognized problem: why assessment of mental status should be the sixth vital sign. J Am Med Dir Assoc. 2007;8(5):273–275.
Meagher DJ. Delirium: optimising management. BMJ. 2001;322(7279):144–149.
Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method: a new method for detecting delirium. Ann Int Med. 1990;113(12):941–948.
Kellett J, Deane B. The simple clinical score predicts mortality for 30 days after admission to an acute medical unit. QJM. 2006;99(11):771–781.
Osler W. Neuroses of the heart. In: Osler W, ed. The Principles and Practice of Medicine. Edinburgh: Young J Pentland; 1901:759.
Criteria Committee of the New York Heart Association. Nomenclature and Criteria for Diagnosis of Diseases of the Heart. 5th ed. New York: New York Heart Association; 1953.
Spodick DH, Raju P, Bishop RL, Rifkin RD. Operational definition of normal sinus heart rate. Am J Cardiol. 1992;69(14):1245–1246.
Scott O, Williams GJ, Fiddler GI. Results of 24-hour ambulatory monitoring of electrocardiogram in 131 healthy boys aged 10 to 13 years. Br Heart J. 1980;44:304–308.
Brodsky M, Wu D, Denes P, Kanakis C, Rosen KM. Arrhythmias documented by 24-hour continuous electrocardiographic monitoring in 50 male medical students without apparent heart disease. Am J Cardiol. 1977;39(3):390–395.
Bjerregaard P. Mean 24-hour heart rate, minimal heart rate, and pauses in healthy subjects 40–79 years of age. Eur Heart J. 1983;4(1):44–51.
Hilgard J, Ezri MD, Denes P. Significance of ventricular pauses of three seconds or more detected on 24-hour Holter recordings. Am J Cardiol. 1985;55(8):1005–1008.
Agruss NS, Rosin EY, Adolph RJ, Fowler NO. Significance of chronic sinus bradycardia in elderly people. Circulation. 1972;46(5):924–930.
Tresch DD, Fleg JL. Unexplained sinus bradycardia: clinical significance and long-term prognosis in apparently healthy persons older than 40 years. Am J Cardiol. 1986;58(10):1009–1013.
Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101(6):1644–1656.
O’Brien E, Murphy J, Tyndall A, et al. Twenty-four-hour ambulatory blood pressure in men and women aged 17 to 80 years: the Allied Irish Bank Study. J Hypertens. 1991;9(4):355–360.
Wonka F. Oscillometric blood pressure measurement: description of the method used. Z Kardiol. 1996;85:1–7.
Beaubien ER, Card CM, Card SE, Biem HJ, Wilson TW. Accuracy of the Dinamap 1846 XT automated blood pressure monitor. J Hum Hypertens. 2002;16(9):647–652.
Deakin CD, Low JL. Accuracy of the advanced trauma support guidelines for predicting systolic blood pressure using carotid, femoral and radial pulses: observational study. BMJ. 2000;321(7262):673–674.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13(10):818–829.
Olsson T, Lind L. Comparison of the rapid emergency medicine score and APACHE II in non-surgical emergency department patients. Acad Emerg Med. 2003;10(10):1040–1048.
Rhee KJ, Fisher CJ, Willitis NH. The rapid acute physiology score. Am J Emerg Med. 1987;5(4):278–286.
Le Gall J-R, Lemeshow S, Saulnier F. A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA. 1993;270(24):2957–2963.
Lemeshow S, Teres D, Klar J, Avrunin JS, Gehlbach SH, Rapport J. Mortality probability models (MPM II) based on an international cohort of intensive care patients. JAMA. 1993;270(20):2478–2486.
Ikeda M, Matsunaga T, Irabu N, Yoshida S. Using vital signs to diagnose impaired consciousness: cross-sectional observational study. BMJ. 2002;325(7378):800–805.
Guyton AC, Hall JE. Textbook of Medical Physiology. 9th ed. Philadelphia: W.B. Saunders; 1996:209–220.
Rady MY, Nightingale P, Little RA, Edwards JD. Shock index: a re-evaluation in acute respiratory failure. Resuscitation. 1992;23(3):227–234.
Rady MY. The role of central venous oximetry, lactic acid concentration and shock index in the evaluation of clinical shock: a review. Resuscitation. 1992;24(1):55–60.
Rady MY, Rivers EP, Martin GB, et al. Continuous central venous oximetry and shock index in the emergency department: use in the evaluation of clinical shock. Am J Emerg Med. 1992;10(6):538–541.
Victor M, Ropper AH. Coma and related disorders of consciousness. In: Adams and Victor’s Principles of Neurology. 7th ed. New York: McGraw-Hill; 2001:366–389.
Birkhahn RH, Gaeta TJ, Bei R, Bove JJ. Shock index in the first trimester of pregnancy and its relationship to ruptured ectopic pregnancy. Acad Emerg Med. 2002;9(2):115–119.
King RW, Plewa MC, Buderer NM, Knotts FB. Shock index as a marker for significant injury in trauma patients. Acad Emerg Med. 1996;3(11):1041–1045.
Rady MY, Smithline HA, Blake H, Nowak R, Rivers E. A comparison of the shock index and conventional vital signs to identify acute critical illness in the emergency department. Ann Emerg Med. 1994;24(4):685–690.
Kline JA, Nelson RD, Jackson RE, Courtney DM. Criteria for the safe use of d-dimer testing in emergency department patients with suspected pulmonary embolism: a multicenter US study. Ann Emerg Med. 2002;39(2):144–152.
Ostern HJ, Trentz O, Hemplemann G, Trentz OA, Sturm J. Cardiorespiratory and metabolic patterns in multiple trauma patients. Resuscitation. 1979;7(3–4):169–183.
Zimmerman JL. In: Taylor RW, Delliner RP, Farmer JC, eds. Fundamental Critical Care Support. 3rd ed. Society of Critical Care Medicine Des Plaines: Illinois; 2001:4–9.
Mackowiak PA. Concepts of fever. Arch Intern Med. 1998;158(7):1870–1881.
Sund-Levander M, Forsberg C, Wahren LK. Normal oral, rectal, tympanic and axillary body temperature in adult men and women: a systematic literature review. Scand J Caring Sci. 2002;16(2):122–128.
Cretikos M, Chen J, Hillman K, et al. The objective medical emergency team activation criteria: a case-control study. Resuscitation. 2007;73(1):62–72.
Lovett PB, Buchwald JM, Sturmann K, Bijur P. The vexatious vital: neither clinical measurements by nurses nor electronic monitor provides accurate measurements of respiratory rate in triage. Ann Emerg Med. 2005;45(1):68–76.
Hooker EA, O’Brien DJ, Danzel DF, Barefoot JAC, Brown JE. Respiratory rates in emergency department patients. J Emerg Med. 1989;7(12):129–132.
Hutchinson J. Thorax. In: Todd RB, ed. Cyclopaedia of Anatomy and Physiology, vol. IV. London: Longman, Brown, Green, Congmans and Roberts; 1849:1079–1087.
Mead J. Control of respiratory frequency. J Appl Physiol. 1960;15(3):325–336.
McFadden JP, Price RC, Eastwood HD, Briggs RS. Raised respiratory rate in elderly patients: a valuable physical sign. BMJ. 1982;284(6316):626–627.
Otis AB, Fenn WO, Rahn H. Mechanics of breathing in man. J Appl Physiol. 1950;2(11):592–607.
McIlroy MB, Marshall R, Christie RV. The work of breathing in normal subjects. Clin Sci. 1954;13:127–136.
Marshall R, Christie RV. The visco-elastic properties of the lungs in acute pneumonia. Clin Sci. 1954;13:403–408.
Sinex JE. Pulse oximetry: principles and limitations. Am J Emerg Med. 1999;17(1):59–67.
Smith GB, Poplett N. Knowledge of aspects of acute care in trainee doctors. Postgrad Med J. 2002;78(920):335–338.
McGee S, Abernethy WB, Simel DL. Is this patient hypovolemic? JAMA. 1999;281(11):1022–1029.
Pilling J, Cutaia M. Ambulatory oximetry monitoring in-patients with severe COPD: a preliminary study. Chest. 1999;116(2):314–321.
Schenkel NS, Burdet L, de Muralt B, Fitting JW. Oxygen saturation during daily activities in chronic obstructive pulmonary disease. Eur Respir J. 1996;9(12):2584–2589.
Rao V, Todd TRJ, Kuus PTA, Buth KJ, Pearson FG. Exercise oximetry versus spirometry in the assessment of risk prior to lung resection. Ann Thorac Surg. 1995;60(3):603–608.
Warner L, Bartlett KA, Charles SA, O’Brien LM. Use of pulse oximetry with exercise in the diagnosis of PCP. Int Conf AIDS. 1991;7:232.
Smith GB, Prytherch DR, Schmidt PE, et al. Should age be included as a component of track and trigger systems used to identify sick adult patients? Resuscitation. 2008;78(2):109–115.
Morgan RJ, Williams F, Wright MM. An early warning scoring system for detecting developing critical illness. Clin Intens Care. 1997;8:100.
Smith GB, Prytherch DR, Schmidt PE, Featherstone PI, Higgins B. A review and performance evaluation of single–parameter “track and trigger” systems. Resuscitation. 2008;79(1):11–21.
Kellett J, Deane B, Gleeson M. Derivation and validation of a score based on Hypotension, Oxygen saturation, low Temperature, ECG changes and Loss of independence (HOTEL) that predicts early mortality between 15 min and 24 h after admission to an acute medical unit. Resuscitation. 2008;78(1):52–58.
Goodacre S, Turner J, Nicholl J. Prediction of mortality among emergency medical admissions. Emerg Med J. 2006;23(5):372–375.
Prytherch DR, Smith GB, Schmidt P, et al. Calculating early warning scores – a classroom comparison of pen and paper and hand-held computer methods. Resuscitation. 2006;70(2):173–178.
Smith GB, Prytherch DR, Schmidt P, et al. Hospital-wide physiological surveillance – a new approach to the early identification and management of the sick patient. Resuscitation. 2006;71(1):19–28.
Hravnak M, Edwards L, Clontz A, Valenta C, DeVita MA, Pinsky MR. Defining the incidence of cardiorespiratory instability in patients in step-down units using an electronic integrated monitoring system. Arch Intern Med. 2008;168(12):1300–1308.
Rooney T, Moloney ED, Bennett K, O’Riordan D, Silke B. Impact of an acute medical admission unit on hospital mortality: a 5–year prospective study. QJM. 2008;101(6):457–465.
Acknowledgement
The authors would like to acknowledge the help of all the medical, nursing and administrative staff of Nenagh Hospital in the collection of data that made this paper possible. In particular, we would like to thank Mrs. Marie Kennedy for her meticulous help.
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Kellett, J., Deane, B., Gleeson, M. (2011). The Meaning of Vital Signs. In: DeVita, M., Hillman, K., Bellomo, R. (eds) Textbook of Rapid Response Systems. Springer, New York, NY. https://doi.org/10.1007/978-0-387-92853-1_11
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