Development of heart and respiratory rate percentile curves for hospitalized children
Related Experiment Video
Updated: May 13, 2026
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Christopher P Bonafide1, Patrick W Brady, Ron Keren
1Division of General Pediatrics, The Children's Hospital of Philadelphia, 34th St and Civic Center Blvd, Suite 12NW80, Philadelphia, PA 19104, USA. bonafide@email.chop.edu
Insights
Hospitalized children frequently have vital signs outside textbook ranges. New percentile curves for heart and respiratory rates can improve clinical monitoring and early warning systems (EWS).
Area of Science:
- Pediatric critical care
- Clinical vital signs monitoring
- Biostatistics in healthcare
Background:
- Current vital sign reference ranges may not accurately reflect hospitalized children's physiology.
- Existing pediatric early warning score (EWS) parameters might misinterpret vital sign deviations.
Purpose of the Study:
- To create and validate heart and respiratory rate percentile curves for hospitalized children.
- To compare vital sign distributions against established textbook ranges and EWS criteria.
Main Methods:
- Utilized 6 months of electronic health record data from 14,014 children across two tertiary care hospitals.
- Developed percentile curves using generalized additive models for location, scale, and shape.
- Validated curves on 33% of the patient cohort, assessing deviations from reference ranges and EWS.
Main Results:
- Analysis included 116,383 heart rate and 116,383 respiratory rate values.
- Up to 54% of heart rate and 40% of respiratory rate observations fell outside textbook reference ranges.
- A significant proportion of vital signs (up to 38% for heart rate, 30% for respiratory rate) could trigger increased EWS.
Conclusions:
- Many hospitalized children exhibit vital signs outside conventional reference ranges and EWS parameters.
- Derived percentile curves offer a potentially more accurate reference for clinical practice.
- These percentiles can inform the development of evidence-based alerts and EWS for improved patient safety.
Objective:
To develop and validate heart and respiratory rate percentile curves for hospitalized children and compare their vital sign distributions to textbook reference ranges and pediatric early warning score (EWS) parameters.
Methods:
For this cross-sectional study, we used 6 months of nurse-documented heart and respiratory rates from the electronic records of 14,014 children on general medical and surgical wards at 2 tertiary-care children's hospitals. We developed percentile curves using generalized additive models for location, scale, and shape with 67% of the patients and validated the curves with the remaining 33%. We then determined the proportion of observations that deviated from textbook reference ranges and EWS parameters.
Results:
We used 116,383 heart rate and 116,383 respiratory rate values to develop and validate the percentile curves. Up to 54% of heart rate observations and up to 40% of respiratory rate observations in our sample were outside textbook reference ranges. Up to 38% of heart rate observations and up to 30% of respiratory rate observations in our sample would have resulted in increased EWSs.
Conclusions:
A high proportion of vital signs among hospitalized children would be considered out of range according to existing reference ranges and pediatric EWSs. The percentiles we derived may serve as useful references for clinicians and could be used to inform the development of evidence-based vital sign parameters for physiologic monitor alarms, inpatient electronic health record vital sign alerts, medical emergency team calling criteria, and EWSs.
Related Concept Videos
01:20Assessment of Ventilation I: Respiratory Rate
A Ventilation assessment is critical for monitoring a patient's health status. Respiration, one of the most accessible vital signs, provides insights into the function of numerous body systems and can indicate serious health issues, such as brainstem injuries from head trauma.
Critical Guidelines for Assessing Ventilation:
01:19Special considerations while measuring oxygen saturation
Ensuring accuracy in vital sign recordings while prioritizing patient comfort and minimizing anxiety is important.
01:27Physical Assessment of the Respiratory Tract II: Inspection
Chest Configuration
The chest configuration can...
01:29Assessment of Ventilation II: Respiratory Depth and Rhythm
Respiratory depth measures the volume of air inhaled or exhaled during a breath. It can vary from shallow to deep and typically remains consistent when a person is at rest or asleep. Occasionally, individuals will automatically inhale deeply, known as sighing, which inflates the lungs with more air than normal breathing.
To assess respiratory depth, observe the degree of chest excursion or movement:
01:19Respiratory Assessment: Purpose and Indications
Objectives and Importance:
The primary goal of respiratory assessment is to evaluate patients at early risk of clinical deterioration. Since respiratory distress often precedes other signs of declining health, breathing patterns and sounds become a...
01:24Factors Affecting Respiration