Heart Rate and Blood Pressure Centile Curves and Distributions by Age of Hospitalized Critically Ill Children

Eytan, Danny; Goodwin, Andrew; Greer, Robert O.; Guerguerian, Anne‐Marie; Laussen, Peter C.

doi:10.3389/fped.2017.00052

Cited by 36 publications

(26 citation statements)

References 18 publications

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“…For example, more than 50% of the children with hypotension according to the APLS were discharged home following ED visit. Two recent studies presented BP reference ranges and distributions for critically ill children but validated reference values for the paediatric ED population are lacking 28 29…”

Section: Discussionmentioning

confidence: 99%

Association between hypotension and serious illness in the emergency department: an observational study

2019

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BackgroundThe value of routine blood pressure measurement in the emergency department (ED) is unclear.ObjectiveTo determine the association between hypotension in addition to tachycardia and the Shock Index for serious illness.DesignObservational study.SettingUniversity ED (2009–2016).Participants, methods and main outcomesRoutine data collected from consecutive children <16 years. Using logistic regression, we assessed the association between hypotension (adjusted for tachycardia) and Shock Index (ratio heart rate/blood pressure [BP]) for serious illness. The predictive accuracy (sensitivity, specificity) for hypotension and Shock Index was determined for serious illness, defined as intensive care unit (ICU) and hospital admissions.ResultsWe included 10 698 children with measured BP. According to three age-adjusted clinical cut-offs (Advanced Paediatric Life Support, Paediatric Advanced Life Support and Paediatric Early Warning Score), hypotension was significantly associated with ICU admission when adjusted for tachycardia (range OR 2.6–5.3). Hypotension showed low sensitivity (range 0.05–0.12) and high specificity (range 0.95–0.99) for ICU admission. Combining hypotension and tachycardia did not change the predictive value for ICU admission. Similar results were found for hospitalisation. Shock index was associated with serious illness. However, no specific cut-off value was identified in different age groups.ConclusionsHypotension, adjusted for tachycardia, is associated with serious illness, although its sensitivity is limited. Shock index showed an association with serious illness, but no acceptable cut-off value could be identified. Routine BP measurement in all children to detect hypotension has limited value in the ED. Future studies need to confirm which patients could benefit from BP measurement.

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Section: Discussionmentioning

confidence: 99%

Association between hypotension and serious illness in the emergency department: an observational study

2019

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“…Optimal values for BP in healthy and critically ill children, including therapeutic thresholds, should be related to the clinical condition, age, sex, and body size [20][21][22][23][24][25]. There was only weak agreement concerning BP values in children under 12 years of age.…”

Section: Arterial Blood Pressurementioning

confidence: 99%

Recommendations for hemodynamic monitoring for critically ill children—expert consensus statement issued by the cardiovascular dynamics section of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC)

et al. 2020

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Background Cardiovascular instability is common in critically ill children. There is a scarcity of published high-quality studies to develop meaningful evidence-based hemodynamic monitoring guidelines and hence, with the exception of management of shock, currently there are no published guidelines for hemodynamic monitoring in children. The European Society of Paediatric and Neonatal Intensive Care (ESPNIC) Cardiovascular Dynamics section aimed to provide expert consensus recommendations on hemodynamic monitoring in critically ill children. Methods Creation of a panel of experts in cardiovascular hemodynamic assessment and hemodynamic monitoring and review of relevant literature—a literature search was performed, and recommendations were developed through discussions managed following a Quaker-based consensus technique and evaluating appropriateness using a modified blind RAND/UCLA voting method. The AGREE statement was followed to prepare this document. Results Of 100 suggested recommendations across 12 subgroups concerning hemodynamic monitoring in critically ill children, 72 reached “strong agreement,” 20 “weak agreement,” and 2 had “no agreement.” Six statements were considered as redundant after rephrasing of statements following the first round of voting. The agreed 72 recommendations were then coalesced into 36 detailing four key areas of hemodynamic monitoring in the main manuscript. Due to a lack of published evidence to develop evidence-based guidelines, most of the recommendations are based upon expert consensus. Conclusions These expert consensus-based recommendations may be used to guide clinical practice for hemodynamic monitoring in critically ill children, and they may serve as a basis for highlighting gaps in the knowledge base to guide further research in hemodynamic monitoring.

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“…Although no large-scale, publicly available resource such as the MIMIC exists in child health research, several groups have recently reported the use of complex, frequently measured pediatric data streams. [124][125][126] Published distributions and patterns for high-frequency vital signs stratified by age 127 and diagnosis 128 will be useful for investigators building clinical decision support tools and specifying thresholds for intervention and targeted outcomes.…”

Section: Predictive Analytics Using Frequently Measured Datamentioning

confidence: 99%

Data Science for Child Health

Bennett

Callahan

Feinstein

et al. 2019

The Journal of Pediatrics

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Data science has revolutionized industry and academic fields including marketing, 1 astronomy, 2 and computer vision. 3 It has not yet impacted medicine and biomedical research to the same degree. However, many observers 4-6 believe that data science will improve the ability of health care systems to deliver personalized medicine, 7 population health, 8 and public health. 9 The US National Institutes of Health (NIH) Strategic Plan for Data Science defines it as "the interdisciplinary field of inquiry in which quantitative and analytical approaches, processes, and systems are developed and used to extract knowledge and insights from increasingly large and/or complex sets of data." 10 One interpretation of this definition is that data science is possible because of relatively cheap data storage and computing, efficient algorithms and computational tools for complex tasks such as optimizing neural network models and analyzing whole exome sequence (WES) data, and the availability of enormous amounts of data. This includes biological (eg, genomic, proteomic, and metabolomic), clinical (eg, laboratory results, digital images, text notes, and monitor signals), lifestyle (mobile sensor output, interactions with applications), and other data with which to train and evaluate models.

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Heart Rate and Blood Pressure Centile Curves and Distributions by Age of Hospitalized Critically Ill Children

Cited by 36 publications

References 18 publications

Association between hypotension and serious illness in the emergency department: an observational study

Association between hypotension and serious illness in the emergency department: an observational study

Recommendations for hemodynamic monitoring for critically ill children—expert consensus statement issued by the cardiovascular dynamics section of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC)

Data Science for Child Health

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