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Towards Evidence-Based Vital Sign Reference Ranges: Centile Charts From Discharge Data in a UK Paediatric Hospital

Nicky Taylor1, Petra Wark2, Jane Coad3,4

  • 1Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK.

Nursing in Critical Care
|February 18, 2026
PubMed

Insights

New vital signs charts for children at hospital discharge show current reference ranges may be inaccurate. This study developed age-specific centile charts for respiratory rate, heart rate, and blood pressure in UK paediatric patients.

Area of Science:

  • Paediatric critical care medicine
  • Clinical physiology
  • Health informatics

Background:

  • Lack of consensus on acceptable vital signs for hospitalised paediatric patients.
  • Need for reliable reference ranges for clinical decision-making in paediatric care.

Purpose of the Study:

  • Develop age-specific centile charts for respiratory rate, heart rate, and systolic blood pressure at hospital discharge.
  • Evaluate alignment of new charts with existing international paediatric vital signs reference ranges.

Main Methods:

  • Cross-sectional study at a UK tertiary paediatric hospital (2014-2019).
  • Utilised routinely collected vital signs data from 66,356 paediatric inpatient admission episodes (0-19 years).
  • Generated centile charts using Quantile restricted cubic splines regression.

Main Results:

  • New centile charts for paediatric vital signs at discharge are presented.
  • Existing Advanced Paediatric Life Support (APLS) reference ranges for respiratory rate and blood pressure show poor alignment with derived centiles.
  • Heart rate centiles align well, but significant variance exists with other clinical reference ranges, particularly at upper centiles.

Conclusions:

  • This study provides the first description of paediatric physiological observations and centile charts from a UK Children's hospital.
  • Current widely used vital signs reference ranges may be inadequate for evaluating paediatric patients, necessitating updated clinical guidelines.
Abstract

Keywords:
centileschildinfantreference standardsregression analysisvital signs

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