The association between prehospital vital signs of children and their critical clinical outcomes at hospitals

Abstract

Vital signs are important for patient assessment, but little is known about interpreting those of children in prehospital settings. We conducted an observational study to investigate the association between prehospital vital signs of children and their clinical outcomes in hospitals. We plotted the data of patients with critical outcomes on published reference ranges, such as those of healthy children to evaluate the clinical relevance. Of the 18,493 children screened, 4477 transported to tertiary hospitals were included in the analysis. The outcomes 12 h after being transported to a tertiary hospital were as follows: deceased, 41; hospitalization with critical deterioration events, 65; hospitalization without critical deterioration events, 1086; returned home, 3090; and unknown, 195. The reference ranges of the heart rates (sensitivity: 57.7%, specificity: 67.5%) and respiratory rates (sensitivity: 54.5%, specificity: 67.7%) of healthy children worked best to detect the critical outcomes. Therefore, the reference ranges of healthy children were concluded to be suitable in prehospital settings; however, excessive reliance on vital signs carried potential risks due to their limited sensitivities and specificities. Future studies are warranted to investigate indicators with higher sensitivities and specificities.

Figure 1

Study population.

Figure 2

Centile curves of the heart rates (a) and respiratory rates (b) of healthy children as developed by Fleming et al. (solid lines), reference ranges of the triage scale of the Kobe City Emergency Transport System (dotted lines), and plots of the study population. C1, the 1st centile; C99, the 99th centile.

Figure 3

Centile curves of the heart rates (a) and respiratory rates (b) of healthy children as developed by Fleming et al. and plots of patients who died or were hospitalized with critical deterioration events. Data on patients without vital signs recorded at the two time points by the emergency medical service providers are not displayed here. Critical Deterioration, hospitalized with critical deterioration events; C1, the 1st centile; C99, the 99th centile.