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Intensive Care Medicine

, Volume 43, Issue 10, pp 1540–1541 | Cite as

Risk of over-diagnosis of hypotension in children: a comparative analysis of over 50,000 blood pressure measurements

  • Samiran RayEmail author
  • Libby Rogers
  • David P. Noren
  • Ranjana Dhar
  • Simon Nadel
  • Mark J. Peters
  • David P. Inwald
Letter

Dear Editor,

Maintaining a ‘normal’ blood pressure (BP) and avoiding hypotension are key goals in critically ill children [1]. Invasive arterial blood pressure (IABP) and non-invasive oscillometric blood pressure (NIBP) measurements are typically used interchangeably despite reports of bias and lack of precision [2, 3, 4, 5].

We compared concurrently recorded IABP and NIBP in two paediatric intensive care units (PICUs). Data were collected from two sources: (1) the electronic health record (EHR) (Intellivue Critical Care and Anaesthesia, Philips Electronics, Netherlands), typically recorded each hour (April 2009–October 2015 from one PICU; April 2012–December 2015 from the other), and (2) from the Etiometry T3 (Etiometry, Boston, MA, USA) system, recorded directly from the patient’s bedside monitor at 5-s intervals (June 2015–June 2016) in one PICU. While concurrence of measurement is assumed from EHR data, this is guaranteed using high-resolution monitor data.

After exclusion of...

Keywords

Systolic Blood Pressure Diastolic Blood Pressure Linear Regression Model Paediatric Intensive Care Unit Electronic Health Record 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Funding information

No direct funding was received for this study. Part of this work was undertaken at UCL GOS Institute of Child Health, which received a proportion of funding from the Department of Health’s NIHR Biomedical Research Centre’s funding scheme.

Author’s contributions

SR, MJP, SN and DPI conceived and designed the study; SR, LR, RD and DPN collected and verified the data; SR and LR analysed the data; SR, MJP and DPI drafted the manuscript, and all authors contributed to and approved the final version of the manuscript.

Compliance with ethical standards

Ethical approval and consent to participate

Ethical approval was not sought as we used routinely collected clinical data retrospectively. Consent to participate was not sought as this is a retrospective observational study and no patient-identifiable data are presented.

Consent to publish

Consent was not sought as no patient-identifiable data are reported.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Conflicts of interest

The authors declare that they have no conflict of interest.

Supplementary material

134_2017_4843_MOESM1_ESM.tif (182 kb)
Supplementary material 1 (TIFF 181 kb)
134_2017_4843_MOESM2_ESM.tif (551 kb)
Supplementary material 2 (TIFF 550 kb)

References

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    Joffe R, Duff J, Garcia Guerra G et al (2016) The accuracy of blood pressure measured by arterial line and non-invasive cuff in critically ill children. Crit Care 20(1):177CrossRefPubMedPubMedCentralGoogle Scholar
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    Clark JA, Lieh-Lai MW, Sarnaik A et al (2002) Discrepancies between direct and indirect blood pressure measurements using various recommendations for arm cuff selection. Pediatrics 110(5):920–923CrossRefPubMedGoogle Scholar
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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2017

Authors and Affiliations

  1. 1.Respiratory, Critical Care and Anaesthesia SectionUCL GOS Institute of Child HealthLondonUK
  2. 2.Paediatric Intensive Care UnitGreat Ormond Street Hospital NHS TrustLondonUK
  3. 3.UCL Clinical Operations Research UnitUniversity College LondonLondonUK
  4. 4.Philips Research North AmericaCambridgeUSA
  5. 5.Paediatric Intensive Care Unit, St Mary’s HospitalImperial College London NHS TrustLondonUK

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