Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL.
Department of Quality Improvement, Children's Hospital of The King's Daughters and Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA.
Ann Emerg Med. 2023 Apr;81(4):402-412. doi: 10.1016/j.annemergmed.2022.09.019. Epub 2022 Nov 17.
To compare Pediatric Advanced Life Support (PALS) vital signs criteria to empirically derived vital signs cut-points for predicting out-of-hospital interventions in children.
We performed a cross-sectional study of pediatric encounters (<18 years) using the 2019 to 2020 datasets of the National Emergency Medical Services Information System, which we randomly divided into equal size derivation and validation samples. We developed age-based centile curves for initial heart rate, respiratory rate, and systolic blood pressure using generalized additive models for location, scale, and shape, which we evaluated in the validation sample. In addition, we compared the proportion of encounters with at least 1 abnormal vital sign when using empirically derived and PALS criteria and calculated their associations with the delivery of out-of-hospital medical interventions (eg, vascular access, medication delivery, or airway maneuvers).
We included 3,704,398 encounters. Among encounters with all 3 vital signs recorded (n=2,595,217), 45.9% had at least 1 abnormal vital sign using empirically derived criteria and 75.6% with PALS derived criteria. A higher proportion of encounters with a heart rate, respiratory rate, or systolic blood pressure less than 10th or more than 90th age-based empirically derived percentile had medical interventions than those with abnormal vital signs using PALS criteria.
PALS criteria classified a high proportion of children as having abnormal vital signs. Empirically derived vital signs developed from out-of-hospital encounters more accurately predict the delivery of the out-of-hospital medical interventions. If externally validated and correlated to inhospital outcomes, these cut-points may provide a useful assessment tool for children in the out-of-hospital setting.
比较儿科高级生命支持（PALS）生命体征标准与经验得出的生命体征临界点，以预测儿童院外干预。
我们使用国家紧急医疗服务信息系统 2019 年至 2020 年的数据进行了一项儿科病例（<18 岁）的横断面研究，我们将其随机分为同等大小的推导和验证样本。我们使用广义加性模型对初始心率、呼吸率和收缩压进行基于年龄的百分位数曲线分析，在验证样本中评估其性能。此外，我们比较了使用经验衍生和 PALS 标准时至少有 1 项异常生命体征的病例比例，并计算了它们与院外医疗干预（例如血管通路、药物输送或气道操作）的相关性。
我们纳入了 3704398 例病例。在记录了所有 3 项生命体征的病例中（n=2595217），45.9%的病例使用经验衍生标准有至少 1 项异常生命体征，75.6%的病例使用 PALS 衍生标准有异常生命体征。与使用 PALS 标准有异常生命体征的病例相比，心率、呼吸率或收缩压小于第 10 个或大于第 90 个基于年龄的经验衍生百分位数的病例接受医疗干预的比例更高。
PALS 标准将很大一部分儿童归类为有异常生命体征。从院外病例中得出的经验衍生生命体征更准确地预测了院外医疗干预的实施。如果经过外部验证并与院内结果相关联，这些临界点可能为院外环境中的儿童提供有用的评估工具。
