Distribution of Pediatric Vital Signs in the Emergency Department: A Nationwide Study

Bae, Woori; Kim, Kyunghoon; Lee, Bong Jin

doi:10.3390/children7080089

Cited by 14 publications

(21 citation statements)

References 17 publications

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“…Healthy toddlers and preschool-aged children with HR/SBP higher than 1.2 are routinely seen in well-child clinics. One strength of the PSI and rPSI is how they account for the higher HR/SBP ratio among younger children 12,13 …”

Section: Discussionmentioning

confidence: 99%

Derivation and validation of an improved pediatric shock index for predicting need for early intervention and outcomes in pediatric trauma

Georgette

Keskey

Hampton

et al. 2022

J Trauma Acute Care Surg

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BACKGROUND:Shock index, pediatric age adjusted (SIPA), has been widely applied in pediatric trauma but has limited precision because of the reference ranges used in its derivation. We hypothesized that a pediatric shock index (PSI) equation based on age-based vital signs would outperform SIPA. METHODS:A retrospective cohort of trauma patients aged 1 to 18 years from Trauma Quality Programs -Participant Use File 2010 to 2018 was performed. A random 70% training subset was used to derive Youden index-optimizing shock index (SI) cutoffs by age for blood transfusion within 4 hours. We used linear regression to derive equations representing the PSI cutoff for children 12 years or younger and 13 years or older. For children 13 years or older, the well-established SI of 0.9 remained optimal, consistent with SIPA and other indices. For children 12 years or younger in the 30% validation subset, we compared our age-based PSI to SIPA as predictors of early transfusion, mortality, pediatric intensive care unit admission, and injury severity score of ≥25. For bedside use, a simplified "rapid" pediatric shock index (rPSI) equation was also derived and compared with SIPA. RESULTS:A total of 439,699 patients aged 1 to 12 years met the inclusion criteria with 2,718 (1.3% of those with available outcome data) requiring transfusion within 4 hours of presentation. In the validation set, positive predictive values for early transfusion were higher for PSI (8.3%; 95% confidence interval [CI], 7.5-9.1%) and rPSI (6.3%; 95% CI, 5.7-6.9%) than SIPA (4.3%; 95% CI, 3.9-4.7%). For early transfusion, negative predictive values for both PSI (99.3%; 95% CI, 99.2-99.3%) and rPSI (99.3%; 95% CI, 99.2-99.4%) were similar to SIPA (99.4%; 95% CI, 99.3-99.4%). CONCLUSION:We derived the PSI and rPSI for use in pediatric trauma using empiric, age-based SI cutoffs. The PSI and rPSI achieved higher positive predictive values and similar negative predictive values to SIPA in predicting the need for early blood transfusion and mortality.

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Section: Discussionmentioning

confidence: 99%

Derivation and validation of an improved pediatric shock index for predicting need for early intervention and outcomes in pediatric trauma

Georgette

Keskey

Hampton

et al. 2022

J Trauma Acute Care Surg

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“…First, one of the most common chief complaints among children visiting an ED is fever, 10 which can increase HR and RR. [11][12][13][14][15] Hospitalization for the treatment of febrile disease or even ICU admission in case of severe disease such as septic shock can therefore be expected. However, bradycardia or bradypnea may appear in a stable situation in which the parasympathetic nervous system is stimulated, rather than in a pathological or stressful situation in which the sympathetic nervous system is hyperactive.…”

Section: Discussionmentioning

confidence: 99%

Pediatric triage modifications based on vital signs: a nationwide study

et al. 2022

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Objective To analyze the clinical significance of a heart rate (HR) or respiratory rate (RR) higher or lower than the normal in pediatric triage.Methods A retrospective observational study was conducted with data from the Korean National Emergency Department Information System. The subjects were children <15 years of age in 2016. Reported HRs and RRs were divided into seven groups: grade -3 (3 or more standard deviations [SDs]<normal), grade -2 (2 SDs<normal), grade -1 (1 SD<normal), grade 0 (normal), grade 1 (1 SD>normal), grade 2 (2 SDs>normal), and grade 3 (3 or more SDs>normal). The main outcomes were hospitalization and intensive care unit (ICU) admission rates. Logistic regression analysis was used to analyze the relationship of the outcomes according to grade in each group.Results Data for 981,297 patients were analyzed. Hospitalization and ICU admission rates increased significantly in the higher HR group (grades 1 to 3; odds ratio [OR], 1.353; P<0.001; OR, 1.747; P<0.001; respectively) and in the higher RR group (OR, 1.144; P<0.001; OR, 1.396; P<0.001; respectively), compared with grade 0 group. In the lower HR group (grades -1 to -3), the hospitalization rate decreased (OR, 0.928; P<0.001), whereas the ICU admission rate increased (OR, 1.207; P=0.001). Although the hospitalization rate increased. In the lower RR group (OR, 1.016; P=0.008), the ICU admission rate did not increase (OR, 0.973; P=0.338).Conclusion Deviations in HR and RR above normal are related to increased risks of hospitalization and ICU admission. However, this association may not apply to deviations below normal.

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“…We then compared these to the paediatric reference ranges cited by the Advanced Paediatric Life Support (APLS) Guidelines (UK) 8 and previously published vital signs reference data. 3,7,9…”

Section: Introductionmentioning

confidence: 99%

Development of reference ranges of vital signs in UK children: comparison with international centiles

Taylor

Wark

Coad

et al. 2022

Preprint

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BackgroundChildren and Young People (CYP) with acute illness require routine assessment of their physiological observations. There is no agreement as to what the standard reference ranges of vital signs in children and young people are. Existing reference ranges of vital signs that are currently used in clinical practice are minimally supported by empirical evidence. They are also sometimes conflicting.MethodsWe conducted a cross-sectional study using 66356 admission episodes to analyze routinely collected age-specific respiratory rate, heart rate, and blood pressure observations of CYP aged 0-19 years old at hospital discharge. Quantile regression with Restricted Cubic Splines was used to model age-specific centiles. These were then compared with standard reference ranges and literature.ResultsNew centile charts for vital signs are presented. Advanced Paediatric Life Support (APLS, 6th Ed.) reference ranges for respiratory rate and blood pressure poorly aligned to the centiles derived in this study although the centiles for heart rate align well. Variance was also demonstrated between the study centiles and those from the clinical papers, with the greatest differences seen in the upper centiles. Similarly, in comparison with APLS reference ranges, heart rate showed best alignment.ConclusionsThis is the first-time physiological observations of CYP in a UK Children’s hospital have been described and centile charts developed. Current widely used reference ranges especially those for Heart Rate and Respiratory Rate are not fit for purpose when evaluating whether the vital signs of a child are normal or otherwise.

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Distribution of Pediatric Vital Signs in the Emergency Department: A Nationwide Study

Cited by 14 publications

References 17 publications

Derivation and validation of an improved pediatric shock index for predicting need for early intervention and outcomes in pediatric trauma

Derivation and validation of an improved pediatric shock index for predicting need for early intervention and outcomes in pediatric trauma

Pediatric triage modifications based on vital signs: a nationwide study

Development of reference ranges of vital signs in UK children: comparison with international centiles

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