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Time to change the reference ranges of children's physiological observations in emergency care? A prospective study

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posted on 2023-04-21, 15:45 authored by L Brennan, C Heal, S Brown, D Roland, AG Rowland

Aim: High heart and respiratory rates are key indicators in many published guidelines to identify and treat serious bacterial infection and sepsis in children, but the credibility of evidence underpinning what is considered abnormal is questionable. This study established the distribution of heart and respiratory rates of children using a large data set to inform debate on what the ‘normal’ range of these should look like. The primary aim was to compare the distribution of heart and respiratory rates measured in children recruited from non-tertiary emergency care settings with those published by Advanced Paediatric Life Support (APLS). The secondary aim was to compare the distribution of this study's data set to other national guidance on what constitutes a severe (high-risk) measurement and previously published data sets.

Method: Prospective study using anonymised patient data, extracted from electronic patient records of children and young people 0–16 years, recruited from three Emergency Departments and one Urgent Care Centre in Northwest England, UK. 

Results: Heart and respiratory rates, including the reporting of values at certain centiles and comparisons of averages. Distribution of heart and respiratory rate were consistently higher than those used by the APLS guidance, resulting in a large proportion exceeding the ‘severe’ cut-offs proposed. This varied greatly by age. 

Conclusions: This study's data set suggests normal heart rate ranges proposed by the APLS and others is too low and therefore ‘abnormal’ measurements encompass too large a proportion. The respiratory rate of this data set was more consistent with the guidelines and other published data sets.

History

Citation

Brennan, L., Heal, C., Brown, S., Roland, D. and Rowland, A.G. (2023), Time to change the reference ranges of children's physiological observations in emergency care? A prospective study. J Paediatr Child Health, 59: 480-486. https://doi.org/10.1111/jpc.16328

Author affiliation

Department of Health Sciences

Version

  • VoR (Version of Record)

Published in

Journal of Paediatrics and Child Health

Volume

59

Pagination

480–486

Publisher

Wiley

issn

1034-4810

eissn

1440-1754

Acceptance date

2022-12-23

Copyright date

2022

Available date

2023-04-21

Language

eng

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