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. 2019 Nov 27;23(1):380.
doi: 10.1186/s13054-019-2653-9.

A comparison of clinical paediatric guidelines for hypotension with population-based lower centiles: a systematic review

Nienke N Hagedoorn  1 , Joany M Zachariasse  1 , Henriette A Moll  2
Affiliations

A comparison of clinical paediatric guidelines for hypotension with population-based lower centiles: a systematic review

Nienke N Hagedoorn et al. Crit Care. .

Abstract

Background: Different definitions exist for hypotension in children. In this study, we aim to identify evidence-based reference values for low blood pressure and to compare these with existing definitions for systolic hypotension.

Methods: We searched online databases until February 2019 (including MEDLINE, EMBASE, Web of Science) using a comprehensive search strategy to identify studies that defined age-related centiles (first to fifth centile) for non-invasive systolic blood pressure in healthy children < 18 years. Existing cut-offs for hypotension were identified in international guidelines and textbooks. The age-related centiles and clinical cut-offs were compared and visualized using step charts.

Results: Fourteen studies with population-based centiles were selected, of which 2 addressed children < 1 year. Values for the fifth centile differed 8 to 17 mmHg for age. We identified 13 clinical cut-offs of which only 5 reported accurate references. Age-related cut-offs for hypotension showed large variability (ranging from 15 to 30 mmHg). The clinical cut-offs varied in agreement with the low centiles. The definition from Paediatric Advanced Life Support agreed well for children < 12 years but was below the fifth centiles for children > 12 years. For children > 12 years, the definition of Parshuram's early warning score agreed well, but the Advanced Paediatric Life Support definition was above the fifth centiles.

Conclusions: The different clinical guidelines for low blood pressure show large variability and low to moderate agreement with population-based lower centiles. For children < 12 years, the Paediatric Advanced Life Support definition fits best but it underestimates hypotension in older children. For children > 12 years, the Advanced Paediatric Life Support overestimates hypotension but Parshuram's cut-off for hypotension in the early warning score agrees well. Future studies should focus on developing reference values for hypotension for acutely ill children.

Keywords: Hypotension; Percentiles; Reference values; Vital signs.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study selection process. BP, blood pressure
Fig. 2
Fig. 2
Clinical definitions for hypotension and range of fifth centile of systolic blood pressure for boys
Fig. 3
Fig. 3
Quality assessment of the studies
See this image and copyright information in PMC

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