Incidence and Recognition of Elevated Triage Blood Pressure in the Pediatric Emergency Department

Ricke, Tracy L.; Hendry, Phyllis L.; Kalynych, Colleen; Buzaianu, Elena M.; Kumar, Vivek; Redfield, Colby

doi:10.1097/pec.0b013e3182307a4b

Cited by 13 publications

(7 citation statements)

References 17 publications

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“…We have previously shown that only 13% of elevated BPs measured in an urban academic pediatric primary care setting were recognized as elevated by providers. 4 These results are similar to those obtained in a pediatric emergency department setting 5 and in a large pediatric primary care setting. 6,7 …”

Section: Introductionsupporting

confidence: 80%

Real-Time Electronic Medical Record Alerts Increase High Blood Pressure Recognition in Children

Brady

Neu

Miller

et al. 2014

Clin Pediatr (Phila)

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Objective Pediatric hypertension remains largely unrecognized. We hypothesized that an electronic medical record (EMR) alert would increase elevated blood pressure (BP) recognition in a pediatric primary care setting. Study Design Pre–post evaluation of a real-time EMR alert and one-time provider educational session. A total of 1305 encounters of children 3 to 21 years with elevated intake BP and no prior hypertension diagnosis were included. Elevated BP recognition and relationship of recognition with cardiovascular disease (CVD) risk factors during the intervention was compared with an historical control. Results Recognition increased from 12.5% to 42% (P < .001). Recognition increased soon after alert implementation and was sustained without evidence of “alert fatigue.” During both periods, presence of CVD risk factors was associated with recognition. However, the magnitude was lesser in the intervention period. Conclusions Real-time EMR alerts substantially increase elevated BP recognition in children. However, underrecognition of elevated BP persisted, highlighting the need for additional strategies to improve provider recognition.

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Section: Introductionsupporting

confidence: 80%

Real-Time Electronic Medical Record Alerts Increase High Blood Pressure Recognition in Children

Brady

Neu

Miller

et al. 2014

Clin Pediatr (Phila)

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“…Several studies have documented a systematic underrecognition of pediatric hypertension, even when blood pressure is measured. [35][36][37] The high frequency (89%) of height measurement in patients whose blood pressure was measured suggests that screening could have occurred at most preventive visits. However, in at least 11% of preventive visits in which blood pressure was measured, blood pressure values could not have been interpreted appropriately.…”

Section: Discussionmentioning

confidence: 99%

Hypertension Screening During Ambulatory Pediatric Visits in the United States, 2000–2009

et al. 2012

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BACKGROUND AND OBJECTIVE: Hypertension occurs in 2% to 5% of children in the United States, and its prevalence has increased during the obesity epidemic. There is no consensus among professional organizations about how frequently blood pressure should be measured in children >3 years old. The purpose of this study was to estimate the frequency of hypertension screening during ambulatory pediatric visits in the United States and to determine patient- and provider-level factors associated with screening during visits specifically for preventive care. METHODS: We analyzed data from a nationally representative sample of ambulatory visits by using the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey from 2000 through 2009. In the subset of visits involving patients aged 3 to 18 years, we estimated the frequency of screening during all visits, preventive visits, and preventive visits in which overweight/obesity was diagnosed. We used multivariable logistic regression to identify patient- and provider-level factors associated with screening. RESULTS: Hypertension screening occurred during 35% of ambulatory pediatric visits, 67% of preventive visits, and 84% of preventive visits in which overweight/obesity was diagnosed. Between 2000 and 2009, the frequency of screening increased in all visits and in preventive visits. Factors independently associated with screening included older age and overweight/obesity diagnosis. CONCLUSIONS: Providers do not measure blood pressure in two-thirds of pediatric visits and one-third of pediatric preventive visits. Providers may understand the importance of screening among overweight/obese children; however, efforts to encourage routine screening, particularly in young children, may be needed.

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“…On one hand, hypotension is a late sign of shock in children and, on the other hand, the triage of children with hypertension in the emergency department may result in high prevalence of false positives 24. Other triage tools, such as MTS,8 Paed CTAS,7 ESI-4,6 and ATS,19 do not include mandatory measurement of blood pressure, but only the initial assessment of clinical signs of shock, such as thin pulses, delayed capillary refill, sweating, and pallor.…”

Section: Discussionmentioning

confidence: 99%

CLARIPED: um novo instrumento para classificação de risco em emergências pediátricas

Magalhães-Barbosa

Prata‐Barbosa

Cunha

et al. 2016

Revista Paulista de Pediatria

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Incidence and Recognition of Elevated Triage Blood Pressure in the Pediatric Emergency Department

Cited by 13 publications

References 17 publications

Real-Time Electronic Medical Record Alerts Increase High Blood Pressure Recognition in Children

Real-Time Electronic Medical Record Alerts Increase High Blood Pressure Recognition in Children

Hypertension Screening During Ambulatory Pediatric Visits in the United States, 2000–2009

CLARIPED: um novo instrumento para classificação de risco em emergências pediátricas

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