Age‐based centiles for diastolic blood pressure among children in the out‐of‐hospital emergency setting
Abstract Objective To compare Pediatric Advanced Life Support (PALS) diastolic blood pressure (DBP) criteria to empirically derived DBP criteria for the prediction of out‐of‐hospital interventions in children. Methods We performed a retrospective study of pediatric (<18 years) encounters from the...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-04-01
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| Series: | Journal of the American College of Emergency Physicians Open |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/emp2.12915 |
| _version_ | 1797843439279144960 |
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| author | Sriram Ramgopal Robert J Sepanski Remle P Crowe Christian Martin‐Gill |
| author_facet | Sriram Ramgopal Robert J Sepanski Remle P Crowe Christian Martin‐Gill |
| author_sort | Sriram Ramgopal |
| collection | DOAJ |
| description | Abstract Objective To compare Pediatric Advanced Life Support (PALS) diastolic blood pressure (DBP) criteria to empirically derived DBP criteria for the prediction of out‐of‐hospital interventions in children. Methods We performed a retrospective study of pediatric (<18 years) encounters from the ESO Data Collaborative, which includes approximately 2000 Emergency Medical Services agencies in the United States. We developed age‐based centile curves for DBP using generalized additive models for location, scale, and shape. We compared the proportion of encounters with a low DBP when using empirically derived and PALS criteria and calculated their associations with the delivery of out‐of‐hospital interventions (advanced airway management, cardiopulmonary resuscitation, cardiac epinephrine, any systemic epinephrine, defibrillation, and bolus intravenous fluids). Results We included 343,129 encounters. When using PALS criteria, 155,564 (45.3%) were classified as having abnormal DBP, including 120,624 (35.2%) with high DBP and 34,940 (10.2%) with low DBP. When using empirically‐derived criteria, 18.6% had an abnormal DBP (ie, a DBP <10th or >90th centile). The accuracy of low DBP for out‐of‐hospital interventions between the two criteria was similar. Conclusion PALS criteria for DBP classified a high proportion of children as having abnormal vital signs, particularly with diastolic hypertension. Empirically derived DBP thresholds more accurately predict the delivery of key out‐of‐hospital interventions. If externally validated, correlated to in‐hospital outcomes, and combined with thresholds for other vital signs, these may better predict the need for out‐of‐hospital interventions. |
| first_indexed | 2024-04-09T17:05:17Z |
| format | Article |
| id | doaj.art-520ff22cc0fe434aaff65383f17aceb4 |
| institution | Directory Open Access Journal |
| issn | 2688-1152 |
| language | English |
| last_indexed | 2024-04-09T17:05:17Z |
| publishDate | 2023-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj.art-520ff22cc0fe434aaff65383f17aceb42023-04-20T18:18:31ZengWileyJournal of the American College of Emergency Physicians Open2688-11522023-04-0142n/an/a10.1002/emp2.12915Age‐based centiles for diastolic blood pressure among children in the out‐of‐hospital emergency settingSriram Ramgopal0Robert J Sepanski1Remle P Crowe2Christian Martin‐Gill3Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago Northwestern University Feinberg School of Medicine Chicago Illinois USADepartment of Quality Improvement Children's Hospital of The King's Daughters Norfolk Virginia USAESO Austin Texas USADepartment of Emergency Medicine University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USAAbstract Objective To compare Pediatric Advanced Life Support (PALS) diastolic blood pressure (DBP) criteria to empirically derived DBP criteria for the prediction of out‐of‐hospital interventions in children. Methods We performed a retrospective study of pediatric (<18 years) encounters from the ESO Data Collaborative, which includes approximately 2000 Emergency Medical Services agencies in the United States. We developed age‐based centile curves for DBP using generalized additive models for location, scale, and shape. We compared the proportion of encounters with a low DBP when using empirically derived and PALS criteria and calculated their associations with the delivery of out‐of‐hospital interventions (advanced airway management, cardiopulmonary resuscitation, cardiac epinephrine, any systemic epinephrine, defibrillation, and bolus intravenous fluids). Results We included 343,129 encounters. When using PALS criteria, 155,564 (45.3%) were classified as having abnormal DBP, including 120,624 (35.2%) with high DBP and 34,940 (10.2%) with low DBP. When using empirically‐derived criteria, 18.6% had an abnormal DBP (ie, a DBP <10th or >90th centile). The accuracy of low DBP for out‐of‐hospital interventions between the two criteria was similar. Conclusion PALS criteria for DBP classified a high proportion of children as having abnormal vital signs, particularly with diastolic hypertension. Empirically derived DBP thresholds more accurately predict the delivery of key out‐of‐hospital interventions. If externally validated, correlated to in‐hospital outcomes, and combined with thresholds for other vital signs, these may better predict the need for out‐of‐hospital interventions.https://doi.org/10.1002/emp2.12915blood pressurechildemergency medical servicesemergency medicinehypertensionhypotension |
| spellingShingle | Sriram Ramgopal Robert J Sepanski Remle P Crowe Christian Martin‐Gill Age‐based centiles for diastolic blood pressure among children in the out‐of‐hospital emergency setting Journal of the American College of Emergency Physicians Open blood pressure child emergency medical services emergency medicine hypertension hypotension |
| title | Age‐based centiles for diastolic blood pressure among children in the out‐of‐hospital emergency setting |
| title_full | Age‐based centiles for diastolic blood pressure among children in the out‐of‐hospital emergency setting |
| title_fullStr | Age‐based centiles for diastolic blood pressure among children in the out‐of‐hospital emergency setting |
| title_full_unstemmed | Age‐based centiles for diastolic blood pressure among children in the out‐of‐hospital emergency setting |
| title_short | Age‐based centiles for diastolic blood pressure among children in the out‐of‐hospital emergency setting |
| title_sort | age based centiles for diastolic blood pressure among children in the out of hospital emergency setting |
| topic | blood pressure child emergency medical services emergency medicine hypertension hypotension |
| url | https://doi.org/10.1002/emp2.12915 |
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