The use of the raw pulse/breathing rate ratio (PBR) as a predictor of mortality and criticality in the emergency department: a retrospective study.

Researchers in China investigated whether a simple calculation using pulse rate divided by breathing rate (called the PBR ratio) could help predict which emergency department patients are at highest risk of death or becoming critically ill. This study is relevant to acupuncture practice because Traditional Chinese Medicine has historically used pulse and breathing assessment as diagnostic tools. The study examined 1,048 patients with fever at a hospital emergency department between April and December 2021. Healthcare workers measured vital signs before any treatment was given and calculated the PBR ratio. The researchers found a U-shaped relationship between the PBR ratio and patient outcomes. The safest range for the PBR ratio was between 4.6 and 6.2 for predicting mortality risk—meaning patients with ratios in this range had the lowest risk of death. When the ratio fell below 4.6 or rose above 6.2, the risk of poor outcomes increased progressively. Interestingly, the PBR ratio performed similarly to a more complex scoring system called the National Early Warning Score (NEWS) in predicting patient mortality. For acupuncture patients, this research validates the traditional Chinese medicine emphasis on pulse and respiration as important health indicators. While this study was conducted in an emergency setting with acutely ill patients, it reinforces the value of careful pulse and breathing assessment that acupuncturists routinely perform during diagnosis. If you're considering acupuncture treatment, ensure you consult with a licensed acupuncturist who is qualified to perform comprehensive diagnostic assessments.

This retrospective observational study from a tertiary hospital in Tianjin, China examined the pulse/breathing rate ratio (PBR) as a predictor of mortality and critical illness in 1,048 emergency department patients aged ≥16 years presenting with fever (April-December 2021). Restricted cubic spline analysis revealed a U-shaped nonlinear relationship between PBR and both mortality and critical illness (p=0.036 and p=0.005, respectively). Optimal PBR range for lowest mortality risk was 4.6-6.2, with risk increasing progressively outside these parameters. For critical illness, the optimal range was 4.6-5.5. Decision curve analysis demonstrated that PBR performed comparably to the National Early Warning Score (NEWS) in predicting mortality, with both achieving net benefit at 4-10% threshold probability and equivalent performance at 7% threshold (identifying 10 mortalities per 100 patients). Clinical significance: This validates traditional pulse and respiration assessment methods used in TCM diagnosis, demonstrating that simple vital sign ratios can provide meaningful prognostic information in acute care settings.