Defining normal ranges and centiles for heart and respiratory rates in infants and children: a cross-sectional study of patients attending an Australian tertiary hospital paediatric emergency department

O’Leary, Fenton; Hayen, Andrew; Lockie, Francis; Peat, Jennifer K.

doi:10.1136/archdischild-2014-307401

Cited by 89 publications

(109 citation statements)

References 16 publications

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“…We used bivariable analyses to determine the association between escalated care as a binary outcome and the independent variables explored, including an age of ≤2 months, 16 respiratory rate of ≥60 breaths per minute, 37 and oxygen saturation of <90%. 1 Multiple imputation was used for missing data.…”

Section: Analysesmentioning

confidence: 99%

Predicting Escalated Care in Infants With Bronchiolitis

Freire¹,

Kuppermann

Zemek

et al. 2018

Pediatrics

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BACKGROUND AND OBJECTIVES:Early risk stratification of infants with bronchiolitis receiving airway support is critical for focusing appropriate therapies, yet the tools to risk categorize this subpopulation do not exist. Our objective was to identify predictors of "escalated care" in bronchiolitis. We hypothesized there would be a significant association between escalated care and predictors in the emergency department. We subsequently developed a risk score for escalated care. METHODS:We conducted a retrospective cohort study of previously healthy infants aged <12 months with bronchiolitis. Our primary outcome was escalated care (ie, hospitalization with high-flow nasal cannula, noninvasive or invasive ventilation, or intensive care admission). The predictors evaluated were age, prematurity, day of illness, poor feeding, dehydration, apnea, nasal flaring and/or grunting, respiratory rate, oxygen saturation, and retractions. . One of 217 (0.5%) infants without predictors received escalated care. The risk score ranged from 0 to 14 points, with the estimated risk of escalated care from 0.46% (0 points) to 96.9% (14 points). The area under the curve was 85%. CONCLUSIONS:We identified variables measured in the emergency department predictive of escalated care in bronchiolitis and derived a risk score to stratify risk of this outcome. This score may be used to aid management and disposition decisions.

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Section: Analysesmentioning

confidence: 99%

Predicting Escalated Care in Infants With Bronchiolitis

Freire¹,

Kuppermann

Zemek

et al. 2018

Pediatrics

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“…The results of several recent large‐scale studies456, 457, 458, 459 examining normal heart rate and respiratory rate in children are not reflected in the threshold values for respiratory rate and heart rate.…”

Section: Introductionmentioning

confidence: 94%

“…There is no basis for requiring the inclusion of body temperature or white blood cell count.The threshold value for respiratory rate overlaps with the normal range.The results of several recent large‐scale studies456, 457, 458, 459 examining normal heart rate and respiratory rate in children are not reflected in the threshold values for respiratory rate and heart rate. …”

Section: Introductionmentioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

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Background and PurposeThe Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016), a Japanese‐specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 in Japanese. An English‐language version of these guidelines was created based on the contents of the original Japanese‐language version.MethodsMembers of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within each team were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ), and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a two‐thirds (>66.6%) majority vote of each of the 19 committee members.ResultsA total of 87 CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J‐SSCG 2012). The approval rate obtained through committee voting, in addition to ratings of the strengths of the recommendation and its supporting evidence were also added to each recommendation statement. We conducted meta‐analyses for 29 CQs. Thirty seven CQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for 5 CQs.ConclusionsBased on the evidence gathered, we were able to formulate Japanese‐specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non‐specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals.

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“…They are more than complicated because although there are published ‘normal values’ which will guide the clinician in knowing whether a child is tachycardic or tachypnoeic, these are in fact reference ranges that were initially based on expert opinion 3. Although meta-analysis shows these reference ranges to be at least somewhat valid,4 it is probably safest not to think of them as ‘normal ranges’ at all since much of the data includes children in abnormal circumstances.…”

Section: Introductionmentioning

confidence: 99%