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Orthostatic changes in normovolemic children: an analysis of the "tilt test"
Insights
The tilt test for orthostatic hypotension is unreliable in children visiting emergency departments. Fever and prolonged diarrhea were the only factors linked to a positive test, which is nonspecific.
Area of Science:
- Pediatric Emergency Medicine
- Cardiovascular Physiology
- Clinical Assessment
Background:
- Orthostatic vital signs are crucial for assessing volume status and autonomic function.
- The tilt table test is commonly used to diagnose orthostatic hypotension.
- Limited data exists on the utility of tilt testing in pediatric emergency settings.
Purpose of the Study:
- To evaluate the diagnostic value of the tilt test in normovolemic children presenting to emergency departments.
- To identify factors influencing orthostatic vital sign changes in children.
- To determine the specificity and utility of the tilt test in this population.
Main Methods:
- Prospective assessment of 455 normovolemic children (ages 4-17) in emergency departments.
- Measurement of blood pressure and pulse rate in supine, sitting, and standing positions.
- Statistical analysis to correlate vital sign changes with age, chief complaint, and clinical factors.
Main Results:
- An increase in pulse rate >20 bpm occurred in 25.4% of children.
- A decrease in systolic blood pressure >20 torr occurred in 10.7% of children.
- Fever and diarrhea >12 hours were associated with positive tilt test results, particularly in younger children.
Conclusions:
- The tilt test has limited value for assessing normovolemic children in acute care settings.
- Positive tilt test results in this context are nonspecific.
- Fever and prolonged diarrhea are key indicators to consider when interpreting orthostatic changes in children.
Abstract:
Orthostatic changes in pulse rate and blood pressure were assessed on 455 normovolemic children between 4 and 17 years of age who visited emergency departments with a variety of complaints. Blood pressures and pulse rates were measured in the upper extremity with the patient supine, sitting, and standing. The postural changes in pulse rate and blood pressure for age groups 4 to 9 years, 10 to 13 years, and 14 to 18 years were computed, and statistical analyses were performed to identify factors predisposing to changes in pulse rate and blood pressure. In all categories of chief complaint, comparable numbers (average 25.4%) of patients had an increase in pulse rate of greater than 20 beats/min. An average of 10.7% of children in each category had a fall in systolic blood pressure greater than 20 torr. Only increasing body temperature, especially in the youngest children, and diarrhea, particularly if more than 12 hours in duration, predisposed to having a "positive tilt test" using these criteria. The "tilt test" for assessing orthostatic hypotension is of little value in assessing normovolemic children presenting for acute care. A positive test result is very nonspecific.