From the Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany (G.S., A.S.R., H.K.N.), DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany (G.S., H.K.N.) Inselspital, Universitätsspital Bern, Department of Pediatric Surgery Bern, Switzerland (S.B.).
J Trauma Acute Care Surg. 2019 Mar;86(3):448-453. doi: 10.1097/TA.0000000000002139.
Data are lacking to provide cutoffs for hypotension in children based on outcome studies and Pediatric Advanced Life Support (PALS), and Advanced Trauma Life Support (ATLS) definitions are based on normal populations. The goal of this study was to compare different normal population based cutoffs including fifth percentile of systolic blood pressure (P5-SBP) in children and adolescents from the German Health Examination Survey for Children and Adolescents (KiGGS), US population data (Fourth Report), and cutoffs from PALS and ATLS guidelines.
Fifth percentile of systolic blood pressure according to age, sex, and height was modeled based on standardized resting oscillometric BP measurements (12,199 children aged 3-17 years) from KiGGS 2003-2006. In addition, we applied the age-adjusted pediatric shock index in the KiGGS study.
The KiGGS P5-SBP was on average 7 mm Hg higher than Fourth Report P5-SBP (5-10 mm Hg depending on age-sex group). For children aged 3 to 9 years, KIGGS P5-SBP at median height follows the formula 82 mm Hg + age; for age 10 to 17 years, the increase was not linear and is presented in a simplified table. Pediatric Advanced Life Support/ATLS thresholds were between KiGGS and Fourth Report until age of 11 years. The adult threshold of 90 mm Hg was reached by KiGGS P5-SBP median height at 8 years, PALS/ATLS at age of 10 years, and Fourth Report P5-SBP at 12 years. The pediatric shock index, which is supposed to identify severely injured children, was exceeded by 2.3% nonacutely ill KiGGS participants.
Our study shows that percentile cutoffs vary by reference population. The 90 mm Hg cutoff for adolescents targets only those in the less than 1% of the low SBP range and represents an undertriage compared with P5 at younger ages according to both KiGGS and Fourth Report. Finally, current pediatric shock index cutoffs when applied to a healthy cohort lead to a relevant percentage of false positives.
Epidemiologic/prognostic, level III.
缺乏基于结局研究和儿科高级生命支持 (PALS) 的儿童低血压截断值的数据，且高级创伤生命支持 (ATLS) 的定义基于正常人群。本研究的目的是比较不同的正常人群截断值，包括德国儿童青少年健康调查 (KiGGS) 中儿童和青少年的收缩压第 5 百分位数 (P5-SBP)、美国人群数据 (第四报告) 以及 PALS 和 ATLS 指南中的截断值。
根据年龄、性别和身高对收缩压第 5 百分位数进行建模，该模型基于 KiGGS 2003-2006 年的标准化静息振荡血压测量值（12199 名 3-17 岁儿童）。此外，我们在 KiGGS 研究中应用了年龄调整后的小儿休克指数。
KiGGS P5-SBP 平均比第四报告 P5-SBP 高 7mmHg（5-10mmHg，取决于年龄性别组）。对于 3 至 9 岁的儿童，KiGGS P5-SBP 在中位数身高处遵循公式 82mmHg+年龄；对于 10 至 17 岁的儿童，增长并非线性，简化表中呈现。儿科高级生命支持/ATLS 截断值在 KiGGS 和第四报告之间，直到 11 岁。KiGGS P5-SBP 中位数身高达到 8 岁时，PALS/ATLS 达到 10 岁时，第四报告 P5-SBP 达到 12 岁时，达到成人 90mmHg 截断值。小儿休克指数旨在识别严重受伤的儿童，2.3%非急性患病的 KiGGS 参与者超过了该指数。
本研究表明，截断值因参考人群而异。90mmHg 截断值仅针对处于收缩压低值范围小于 1%的青少年，与 KiGGS 和第四报告相比，在年龄较小的青少年中代表低分级。最后，当应用于健康队列时，当前的小儿休克指数截断值导致了相当比例的假阳性。
流行病学/预后，III 级。
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