OBJECTIVE: Previous studies have suggested a link between heart rate (HR) 
following trauma and the development of posttraumatic stress disorder (PTSD). 
This study expands on previous work by evaluating HR in burn patients followed 
longitudinally for symptoms of acute stress disorder (ASD) and PTSD.
METHOD: Data were collected from consecutive patients admitted to the Johns 
Hopkins Burn Center, Baltimore, Maryland, between 1997 and 2002. Patients 
completed the Stanford Acute Stress Reaction Questionnaire (n = 157) to assess 
symptoms of ASD. The Davidson Trauma Scale was completed at 1 (n = 145), 6 (n = 
106), 12 (n = 94), and 24 (n = 66) months postdischarge to assess symptoms of 
PTSD. Heart rate in the ambulance, emergency room, and burn unit were obtained 
by retrospective medical chart review.
RESULTS: Pearson correlations revealed a significant relationship between HR in 
the ambulance (r = 0.32, P = .016) and burn unit (r = 0.30, P = .001) and ASD 
scores at baseline. Heart rate in the ambulance was related to PTSD avoidance 
cluster scores at 1, 6, 12, and 24 months. In women, HR in the ambulance was 
correlated with PTSD scores at 6 (r = 0.65, P = .005) and 12 (r = 0.78, P = 
.005) months. When covariates (gender, β-blockers, Brief Symptom Inventory 
Global Severity Index score) were included in multivariate linear regression 
analyses, ambulance HR was associated with ASD and PTSD scores at baseline and 1 
month, and the interaction of ambulance HR and gender was associated with PTSD 
scores at 6 and 12 months. Multivariate logistic regression results were similar 
at baseline and 12 months, which included an HR association yet no interaction 
at 6 months and a marginal interaction at 1 month.
CONCLUSIONS: While peritraumatic HR is most robustly associated with PTSD 
symptom severity, HR on admission to burn unit also predicts the development of 
ASD. Gender and avoidance symptoms appear particularly salient in this 
relationship, and these factors may aid in the identification of subgroups for 
which HR serves as a biomarker for PTSD. Future work may identify endophenotypic 
measures of increased risk for PTSD, targeting subgroups for early intervention.