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Validation of the APLS age-based vital signs reference ranges in a Chinese population
S S W Chan1, G N Cattermole, P Y M Leung
1Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong. stewart chan@hotmail.com
Insights
Vital signs reference ranges differ by ethnicity. This study found APLS ranges are often inappropriate for Chinese children, necessitating locally derived data for accurate pediatric care.
Area of Science:
- Pediatrics
- Clinical Physiology
- Public Health
Background:
- Vital signs reference ranges can vary significantly across different ethnic groups.
- Existing pediatric vital signs reference ranges may not be universally applicable.
Purpose of the Study:
- To validate the Advanced Paediatric Life Support (APLS) age-based vital signs reference ranges in Chinese children in Hong Kong.
- To derive age-based centile curves for systolic blood pressure, heart rate, and respiratory rate specific to Chinese children.
- To create a summarized table of reference ranges for APLS application in ethnic Chinese patients.
Main Methods:
- A cross-sectional study of 1353 healthy Chinese children (12 months to 143 months) in Hong Kong.
- Measurements of heart rate, systolic blood pressure, and respiratory rate were taken by trained operators.
- Statistical analysis included Z-tests and one-sample t-tests, with LMS Chartmaker Pro used for centile curve derivation.
Main Results:
- A significant proportion of measurements fell outside APLS ranges: 34.1% for heart rate, 55.9% for systolic blood pressure, and 55.7% for respiratory rate.
- Chinese children in pre-school and school age groups showed significantly higher mean blood pressure and lower mean heart and respiratory rates compared to APLS values.
- The study highlights ethnic-specific variations in pediatric vital signs.
Conclusions:
- The Advanced Paediatric Life Support (APLS) age-based vital signs reference ranges require validation for diverse ethnic populations.
- Independently derived vital signs reference ranges are more appropriate for applying APLS to Chinese patients in Hong Kong.
- This research supports the need for localized vital signs data in pediatric emergency care.
Unlabelled:
Reference ranges for vital signs may differ significantly among children of different ethnic origins.
Aim:
(1) To validate the Advanced Paediatric Life Support (APLS) age-based vital signs reference ranges in Chinese children in Hong Kong. (2) To derive age-based centile curves for systolic blood pressure, heart rate and respiratory rate for Chinese children. (3) To summarize the reference ranges in a table format appropriate for applying APLS to ethnic Chinese patients.
Method:
A cross-sectional study was performed on a population of healthy Chinese children recruited from 8 kindergartens and 6 primary schools in Hong Kong. Trained operators visit the sites to obtain measurements. Age-groups: small toddlers (12-23 months); pre-school (24-59 months); and school (60-143 months). Z-test was used to assess statistical significance for proportions of each parameter falling outside the APLS reference range. One-sample t-test was used for comparison with APLS means according to age-groups. LMS Chartmaker Pro v2.3 software was used to describe the data in centile curves.
Results:
A total of 1353 patients (55.1% boys) were included. For heart rate, systolic blood pressure and respiratory rate respectively, 34.1%, 55.9% and 55.7% of corresponding measurements were outside the APLS age-based reference ranges. In the 'pre-school' and 'school' age-groups, the mean value for blood pressure is significantly higher, and the mean values for heart rate and respiratory rate significantly lower, in comparison to APLS mean values.
Conclusion:
Independently derived vital signs reference ranges are more appropriate for use when applying APLS to Chinese patients in Hong Kong.
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