Benefit of BP Measurement in Pediatric ED Patients
Karen M Poor1, Tamara Bostrack Ducklow
1ED/ICU/Telemetry, HealthEast Woodwinds Health Campus, Woodbury, MN 55125, USA.
Insights
Routine blood pressure (BP) checks in young children in the emergency department (ED) show limited utility. Elevated BP readings were more common in younger children and those who were not calm, but overall benefits are minimal.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Utility of Vital Signs
- Hypertension in Children
Background:
- Blood pressure (BP) measurement is standard in pediatric emergency departments (EDs).
- Evidence supporting the clinical utility of routine BP acquisition in young children is limited.
- This study investigates the value of BP measurements in children aged five years and under.
Purpose of the Study:
- To assess the benefit and yield of obtaining blood pressure measurements in pediatric emergency department patients aged five years and younger.
- To analyze the relationship between abnormal blood pressures and patient age, acuity, and emotional state (calm vs. not-calm).
Main Methods:
- Prospective study conducted in two community hospital EDs.
- Data collected by ED triage nurses on 649 pediatric patients (≤5 years).
- Analysis of relationships between abnormal BP readings and patient demographics, acuity (Emergency Severity Index - ESI levels 3 and 4), and emotional state.
Main Results:
- Significant differences in elevated BP rates were observed between calm and not-calm patient groups.
- One- and two-year-old patients showed a higher likelihood of elevated BPs compared to other age groups.
- Hypotension was rare (1%); no relationship found between ESI acuity and abnormal BP.
- Nineteen percent of calm patients had elevated BPs, with 3.6% classified as stage two hypertension.
Conclusions:
- Limited clinical benefit exists in obtaining routine blood pressure measurements for children aged five years or younger.
- BP acquisition in this age group offers minimal added value, irrespective of the child's emotional state or ESI acuity levels 3 and 4.
- Findings suggest a need to re-evaluate the standard practice of routine BP measurement in young pediatric ED patients.
Abstract:
Introduction. Obtaining blood pressures in pediatric emergency department patients is the standard of care; however, there is little evidence to support its utility. This prospective study assesses the benefit of BP acquisition in patients ≤5 years. Methods. Data were collected by the ED triage nurses on 649 patients in two community hospital EDs. Relationships between abnormal blood pressures and the patients' age, acuity, and calm versus not-calm emotional state were analyzed. Results. There were significant differences in the rate of elevated BPs in the calm and not-calm groups of patients. Overall, one- and two-year-old patients were more likely to have elevated BPs than those in other age groups. Very few patients in the sample had hypotension (1%). There was no relationship between Emergency Severity Index (ESI) acuity level and an abnormal BP. Nineteen percent of calm patients had elevated BPs, with 3.6% of patients in the stage two class of hypertension. Conclusions. There is limited benefit in obtaining BPs in children age of five or less regardless of whether the child is calm or not in ESI acuity levels 3 and 4.
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