Time to change the reference ranges of children’s physiological observations in emergency care? A prospective study

Brennan, L; Heal, C; Brown, S; Roland, D; Rowland, AG

Abstract

Background
High heart and respiratory rates are key indicators in many published guidelines to identify
and treat serious bacterial infection and sepsis in children but the credibility of evidence
underpinning what is considered abnormal is questionable. This study established the
distribution of heart and respiratory rates of children using a large dataset to inform debate
on what the ‘normal’ range of these should look like.
Aims
Primary aim: to compare the distribution of heart and respiratory rates measured in
children recruited from non-tertiary emergency care settings with those published by
Advanced Paediatric Life Support (APLS).
Secondary aims: to compare the distribution of this study’s dataset to other national
guidance on what constitutes a severe (high risk) measurement and previously published
datasets.
Design
Prospective study using anonymised patient data, extracted from electronic patient
records.
Participants and setting
Children and young people 0-16 years, recruited from three Emergency Departments and
one Urgent Care Centre in Northwest England, UK.
Outcome measures
Heart and respiratory rates, including the reporting of values at certain centiles and
comparisons of averages.
Results
Distribution of heart and respiratory rate were consistently higher than those used by the
APLS guidance, resulting in a large proportion exceeding the ‘severe’ cut-offs proposed.
This varied greatly by age.
Conclusion
This study’s dataset suggests normal heart rate ranges proposed by the APLS and others
is too low and therefore ‘abnormal’ measurements encompass too large a proportion. The
respiratory rate of this dataset was more consistent with the guidelines and other
published datasets.

• Journal Article Type: Article
• Acceptance Date: Dec 23, 2022
• Online Publication Date: Jan 16, 2023
• Publication Date: Jan 16, 2023
• Deposit Date: Jan 9, 2023
• Publicly Available Date: Feb 2, 2023
• Journal: Journal Of Paediatrics And Child Health
• Print ISSN: 1034-4810
• Electronic ISSN: 1440-1754
• Publisher: Wiley
• DOI: https://doi.org/10.1111/jpc.16328
• Publisher URL: https://doi.org/10.1111/jpc.16328