TY - JOUR

T1 - Time to change the reference ranges of children's physiological observations in emergency care?

T2 - A prospective study

AU - Brennan, Louise

AU - Heal, Calvin

AU - Brown, Stephen

AU - Roland, Damian

AU - Rowland, Andrew G

PY - 2023/3/31

Y1 - 2023/3/31

N2 - 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.

AB - 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.

KW - emergency medicine

KW - general paediatrics

KW - infectious diseases

KW - intensive care

U2 - 10.1111/jpc.16328

DO - 10.1111/jpc.16328

M3 - Journal article

VL - 59

SP - 480

EP - 486

JO - Journal of Paediatrics and Child Health

JF - Journal of Paediatrics and Child Health

SN - 1034-4810

IS - 3

ER -