Benefit of BP Measurement in Pediatric ED Patients

Introduction. Obtaining blood pressures in pediatric emergency department patients is the standard of care; however, there is little evidence to support its utility. This prospective study assesses the benefit of BP acquisition in patients ≤5 years. Methods. Data were collected by the ED triage nurses on 649 patients in two community hospital EDs. Relationships between abnormal blood pressures and the patients’ age, acuity, and calm versus not-calm emotional state were analyzed. Results. There were significant differences in the rate of elevated BPs in the calm and not-calm groups of patients. Overall, one- and two-year-old patients were more likely to have elevated BPs than those in other age groups. Very few patients in the sample had hypotension (1%). There was no relationship between Emergency Severity Index (ESI) acuity level and an abnormal BP. Nineteen percent of calm patients had elevated BPs, with 3.6% of patients in the stage two class of hypertension. Conclusions. There is limited benefit in obtaining BPs in children age of five or less regardless of whether the child is calm or not in ESI acuity levels 3 and 4. 1. Introduction The standard of care in emergency departments is to obtain a blood pressure (BP) during the triage of an injured or ill pediatric patients. Obtaining a BP in pediatric patients, particularly in children under the age of 5 years, is often difficult. Moro-Sutherland [1] notes that “an accurate BP measurement can be difficult to obtain in a young, active, or crying child; can be time-consuming; and requires the use of a properly sized cuff.” This process can be a discomforting or even traumatizing experience. Studies have shown that BP acquisition in the pediatric emergency population is inconsistent and variable [2–4]. BPs are obtained in the ED to assess for either hypotension or hypertension. Hypotension in children is considered to be a late sign of decreased tissue perfusion. Tachycardia, cool and pale distal extremities, prolonged capillary refill, weak pulses, depressed mental status, tachypnea, and decreased urinary output are present prior to a decrease in the systolic BP [5]. The incidence of hypertension in the pediatric population is thought to be approximately 3.6% [6], although, with the epidemic of obesity in children, that number may be higher [7]. Numerous studies have shown a correlation between hypertension in adolescence and cardiovascular disease later in life; however, that correlation does not seem to be strong until the patient is more than five years of age [8]. The Fourth Report on the Diagnosis,