Elevated BPs in Pediatric ERs Go Unrecognized

BPs elevated in more than half of pediatric patients triaged; only recognized in 1 percent

TUESDAY, Dec. 6 (HealthDay News) -- More than half of the patients under 18 years of age triaged in the emergency department may have elevated blood pressure (BP), with very few of these patients being recognized as having elevated BP, according to research published in the October issue of Pediatric Emergency Care.

Tracy L. Ricke, M.D., of the University of Florida College of Medicine in Jacksonville, and colleagues analyzed data from 906 randomly selected patients under the age of 18 who were triaged at a large academic institution's pediatric emergency department over 13 months. BP measurements during and after triage were categorized as normal or elevated (≥90th to <95th, (≥95th to 99th percentile plus 4 mm Hg, and ≥99th percentile plus 5 mm Hg). Recognition of elevated BPs by the physician, level of training, and specialty were also collected. Other factors analyzed included demographics and possible confounding variables (pain, weight, medications, and triage level). Patients with known hypertension or related conditions were excluded, as were those without a triage BP reading.

According to the researchers, elevated blood pressures were found in an unexpected 54.7 percent (496/906) of patients under 18, and only 1 percent (seven of 906) were recognized as having elevated blood pressures. Of the 748 patients between the ages of 1 and 18, 152 had severely elevated BP, with only five recognized by physicians.

"In this study, more than half of the patients had elevated triage BP (≥90th percentile), which was rarely recognized by emergency department practitioners regardless of specialty or experience. Early recognition of elevated triage BP offers opportunities for diagnosis of hypertension and related disorders but is challenging to accomplish," the authors write.

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