Are Orthostatic Vital Signs Helpful in the ED?

Orthostatic vital signs in older emergency department patients require a shift in focus from traditional hypovolemia assessment to the identification of symptomatic orthostatic hypotension. While early emergency medicine literature often dismissed these measurements due to high rates of false positives in younger, euvolemic populations, clinical guidelines for syncope and falls now emphasize their utility in older adults. Accurate assessment involves measuring blood pressure at one and three minutes after standing, specifically looking for a systolic drop of at least 20 mmHg or a diastolic drop of 10 mmHg. Crucially, clinicians must correlate these findings with patient symptoms to avoid misattributing syncope or falls to orthostatic causes. Management focuses on medication review and non-pharmacological maneuvers, such as slow position changes, to mitigate risks and prevent unnecessary hospitalizations. Maura Kennedy, Chief of the Division of Geriatric Emergency Medicine at MassGen, provides this clinical framework.