An evaluation of physiological parameters of stress in the emergency department

Seven physiological parameters previously used in stress research were studied to determine which would be able to quantitate levels of stress and study interventions in the emergency department setting. Eighteen emergency medicine personnel were prospectively studied. Sequential measurements of heart rate, respiratory rate, systolic blood pressure, diastolic blood pressure, skin temperature, serum norepinephrine, and serum epinephrine were recorded during multiple shifts in the emergency department. These parameters were assessed in repeated measures analysis of variance models with the subject's stress score of the shift and a calculated stress score of the shift. Respiratory rate demonstrated a significant association with the score of the shift over time within subjects (P = .0228). Skin temperature showed a significant trend over time (P = .0001) and in relation to how stressful the subject perceived the shift to be (P = .0006). A significant association was detected between epinephrine change over the shift and the subject's perception of the stress of the shift (P = .0217), and the stress score of the shift (P = .0009). Sequential serum epinephrine appears to be an objective measure of both perceived stressfulness of a shift and objective stress scoring of the shift. Respiratory rate changes and skin temperature changes over a shift may also be useful to measure stress in individuals in this setting.