Key result
Non-acute traumatic injury linked to ~8.5 ms lower RMSSD versus uninjured controls.
Why the study?
The relationship between unselected long-term traumatic injury and heart rate variability had not been investigated.
Does non-acute traumatic injury reduce heart rate variability in adults compared to uninjured controls?
Meta-Analysis (n=461)
Does non-acute traumatic injury reduce heart rate variability in adults compared to uninjured controls?
Effect estimate: MD -8.45 ms (95% CI -12.78, -4.12)
p-value: p=<0.0001
Non-acute traumatic injury is associated with attenuated heart rate variability, indicating autonomic imbalance that may explain greater cardiovascular risk following injury.
Attenuated HRV may signal higher post-injury CV risk; leaves open causal confirmation and intervention targets.
Heart rate variability (HRV) is a non-invasive measure of autonomic function. The relationship between unselected long-term traumatic injury (TI) and HRV has not been investigated. This systematic review examines the impact of non-acute TI (>7 days post-injury) on standard HRV indices in adults. Four electronic databases (CINAHL, Medline, Scopus, and Web of Science) were searched. The quality of studies, risk of bias (RoB), and quality of evidence (QoE) were assessed using Axis, RoBANS and GRADE, respectively. Using the random-effects model, mean difference (MD) for root mean square of successive differences (RMSSD) and standard deviation of NN-intervals (SDNN), and standardized mean difference (SMD) for Low-frequency (LF): High-Frequency (HF) were pooled in RevMan guided by the heterogeneity score (I2). 2152 records were screened followed by full-text retrieval of 72 studies. 31 studies were assessed on the inclusion and exclusion criteria. Only four studies met the inclusion criteria. Three studies demonstrated a high RoB (mean RoBANS score 14.5±3.31) with a low QoE. TI was associated with a significantly higher resting heart rate. Meta-analysis of three cross-sectional studies demonstrated a statistically significant reduction in RMSSD (MD -8.45ms, 95%CI-12.78, -4.12, p<0.0001) and SDNN (MD -9.93ms, 95%CI-14.82, -5.03, p<0.0001) (low QoE) in participants with TI relative to the uninjured control. The pooled analysis of four studies showed a higher LF: HF ratio among injured versus uninjured (SMD 0.20, 95%CI 0.01-0.39, p<0.04) (very low QoE). Albeit low QoE, non-acute TI is associated with attenuated HRV indicating autonomic imbalance. The findings might explain greater cardiovascular risk following TI. Trial registration PROSPERO registration number: CRD: CRD42021298530.
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Maqsood et al. (2023) conducted a meta-analysis in Non-acute Traumatic Injury (n=461). Non-acute Traumatic Injury vs. Uninjured controls was evaluated on Root mean square of successive differences (RMSSD) (MD -8.45 ms, 95% CI -12.78, -4.12, p=<0.0001). Non-acute traumatic injury was associated with a statistically significant reduction in heart rate variability, including RMSSD (MD -8.45 ms), compared to uninjured controls.
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