Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington at Seattle Children's Hospital, Seattle, WA.
Enterprise Analytics, Seattle Children's Hospital, Seattle, WA.
Pediatr Crit Care Med. 2020 Sep;21(9):e759-e768. doi: 10.1097/PCC.0000000000002495.
To develop and validate age-specific percentile curves of measured mean arterial pressure for children in a hospital setting.
Retrospective observational study of electronic records.
Tertiary care, freestanding pediatric hospital in Seattle, WA.
Nonpremature children, birth to 18 years old, evaluated in the emergency room, or admitted to either acute care or critical care units.
Oscillometric blood pressure data collected from February 2012 to June 2016 were examined for documentation of systolic, diastolic, and mean arterial pressure values. Quantile curves were developed using restricted cubic splines and validated with two sets of patient data. The effects of birth sex and behavioral state on the curves were examined. The frequency of values less than 5th percentile for mean arterial pressure within a population was compared with four published criteria for hypotension.
Eighty-five-thousand two-hundred ninety-eight patients (47% female) provided 2,385,122 mean arterial pressure readings to develop and validate age-based distributions to create percentile curves and a reference table. The behavior state of patients affected the curves, with disturbed behavior state more prevalent in toddler-aged patients. There was no clinical difference between females and males within age brackets. Mean arterial pressure quantiles identified additional hypotensive episodes as compared with systolic blood pressure thresholds and predicted mean arterial pressure values. Code and data available at: https://osf.io/upqtv/.
This is the first study reporting age-specific quantiles of measured mean arterial pressure in children in a hospital setting. The percentile curves may guide care in illnesses when perfusion pressure is critical and serve as parameter for bedside and electronic record-based response to clinical change. Future work to correlate threshold mean arterial pressure values with outcomes would be feasible based on quantile curves.
为医院环境中的儿童制定并验证特定年龄组的有创平均动脉压百分位曲线。
电子病历的回顾性观察性研究。
华盛顿州西雅图市的一家三级保健、独立儿科医院。
非早产儿，年龄在出生至 18 岁之间，在急诊室接受评估，或收入急性护理或重症监护病房。
从 2012 年 2 月至 2016 年 6 月收集的示波法血压数据，用于记录收缩压、舒张压和平均动脉压值。使用限制立方样条法开发分位数曲线，并使用两组患者数据进行验证。检查了出生性别和行为状态对曲线的影响。比较了人群中平均动脉压值小于第 5 百分位数的频率与四种发表的低血压标准。
85298 名患者（47%为女性）提供了 2385122 次平均动脉压读数，用于开发和验证基于年龄的分布，以创建百分位曲线和参考表。患者的行为状态影响曲线，行为紊乱在幼儿患者中更为常见。在年龄组内，女性和男性之间没有临床差异。与收缩压阈值和预测平均动脉压值相比，平均动脉压分位数确定了更多的低血压发作。代码和数据可在以下网址获取：https://osf.io/upqtv/。
这是第一项在医院环境中报告特定年龄组有创平均动脉压百分位的研究。百分位曲线可指导灌注压至关重要的疾病的护理，并可作为床边和电子病历基于临床变化的反应参数。基于分位数曲线，将来进行阈值平均动脉压值与结局相关性的研究是可行的。
