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. 2013 Apr;131(4):e1150-7.
doi: 10.1542/peds.2012-2443. Epub 2013 Mar 11.

Development of heart and respiratory rate percentile curves for hospitalized children

Christopher P Bonafide  1 , Patrick W Brady, Ron Keren, Patrick H Conway, Keith Marsolo, Carrie Daymont
Affiliations

Development of heart and respiratory rate percentile curves for hospitalized children

Christopher P Bonafide et al. Pediatrics. 2013 Apr.

Abstract

Objective: To develop and validate heart and respiratory rate percentile curves for hospitalized children and compare their vital sign distributions to textbook reference ranges and pediatric early warning score (EWS) parameters.

Methods: For this cross-sectional study, we used 6 months of nurse-documented heart and respiratory rates from the electronic records of 14,014 children on general medical and surgical wards at 2 tertiary-care children's hospitals. We developed percentile curves using generalized additive models for location, scale, and shape with 67% of the patients and validated the curves with the remaining 33%. We then determined the proportion of observations that deviated from textbook reference ranges and EWS parameters.

Results: We used 116,383 heart rate and 116,383 respiratory rate values to develop and validate the percentile curves. Up to 54% of heart rate observations and up to 40% of respiratory rate observations in our sample were outside textbook reference ranges. Up to 38% of heart rate observations and up to 30% of respiratory rate observations in our sample would have resulted in increased EWSs.

Conclusions: A high proportion of vital signs among hospitalized children would be considered out of range according to existing reference ranges and pediatric EWSs. The percentiles we derived may serve as useful references for clinicians and could be used to inform the development of evidence-based vital sign parameters for physiologic monitor alarms, inpatient electronic health record vital sign alerts, medical emergency team calling criteria, and EWSs.

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Figures

FIGURE 1
FIGURE 1
Percentile curves for HR and RR in hospitalized children. Dotted lines represent sensitivity analysis excluding diseases of the respiratory system. The solid vertical line at 1 year of age represents a change in scale of the x-axis.
FIGURE 2
FIGURE 2
Scatterplot array showing the distribution of HR and RR in the study sample compared with textbook reference ranges. Each point on the scatterplot represents 1 vital sign observation. For each reference range, observations that would be considered normal are colored black, and observations that would be considered abnormal are colored red. We found that 12% to 54% of HR observations and 32% to 40% of RR observations in our study sample deviated from the ranges provided.
FIGURE 3
FIGURE 3
Scatterplot array showing the distribution of HR and RR in the study sample in comparison with existing EWS point ranges. Each point on the scatterplot represents 1 vital sign observation. For each score, observations that would score 0 points are colored black, and observations that would score 1, 2, 3, or 4 points are colored according to each scatter plot’s legend. We found that 14% to 38% of HR observations and 15% to 30% of respiratory rate observations would have resulted in increased total EWSs.
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