Orthostatics Are Useful in Assessing Volume Status: Myth or Reality?

Orthostatic vital signs (OVS) have long been a routine part of volume assessment in the emergency department. However, recent evidence demonstrates poor sensitivity and specificity for detecting moderate hypovolemia, with high variability across patient populations. This article reviews the physiologic basis, diagnostic limitations, and alternative methods for assessing intravascular volume, including point-of-care ultrasound and dynamic indices. Ultimately, OVS remain a simple bedside adjunct but should be interpreted cautiously and within the broader clinical context.