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

Nienke N Hagedoorn1, Joany M Zachariasse1, Henriette A Moll1

  • 1Department of Pediatrics, Erasmus MC-Sophia, Rotterdam, The Netherlands.

Archives of Disease in Childhood
|April 6, 2019
PubMed

Insights

Routine blood pressure measurement in children in the emergency department has limited value for detecting serious illness. Hypotension, adjusted for tachycardia, is linked to critical outcomes, but its low sensitivity means it

Area of Science:

  • Pediatric Emergency Medicine
  • Clinical Diagnostics
  • Critical Care

Background:

  • The clinical utility of routine blood pressure (BP) measurement in pediatric emergency departments (EDs) remains uncertain.
  • Assessing the association between hypotension, tachycardia, and the Shock Index is crucial for identifying serious illness in children.

Purpose of the Study:

  • To evaluate the predictive value of hypotension (adjusted for tachycardia) and the Shock Index for serious illness in children presenting to the ED.
  • To determine the sensitivity and specificity of these parameters for predicting intensive care unit (ICU) and hospital admissions.

Main Methods:

  • An observational study analyzed routine data from 10,698 children under 16 years old in a university ED from 2009 to 2016.
  • Logistic regression was used to assess the association between hypotension (adjusted for tachycardia) and the Shock Index with serious illness.
  • Predictive accuracy (sensitivity, specificity) for serious illness (ICU/hospital admission) was determined.

Main Results:

  • Hypotension, adjusted for tachycardia, was significantly associated with ICU admission (odds ratio range 2.6-5.3) across different age-adjusted clinical cut-offs.
  • Hypotension demonstrated low sensitivity (0.05-0.12) but high specificity (0.95-0.99) for ICU admission.
  • The Shock Index was associated with serious illness, but no specific age-independent cut-off value was identified. Combining hypotension and tachycardia did not improve predictive value.

Conclusions:

  • Hypotension, even when adjusted for tachycardia, is linked to serious illness in children but has limited sensitivity for predicting critical outcomes.
  • While the Shock Index shows an association with serious illness, a reliable cut-off value could not be established.
  • Routine BP measurement in all pediatric ED patients has limited value; further research is needed to identify specific patient groups who would benefit from BP monitoring.
Abstract

Keywords:
emergency medical servicehypotensionpredictive valueserious illnessvital signs

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