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Update of the pediatric hypotension graphic adjusted for gender and height percentiles: systolic blood pressure for girls, 1 to 17 years old
Critical Care volume 17, Article number: P22 (2013)
Introduction
According to the National Heart, Lung, and Blood Institute of the National Institute of Health, hypotension refers to an abnormally low blood pressure (BP). In childhood, hypotension can be determined according to two different definitions: BP below the 5th percentile or below two standard deviations (SDs) of the mean for age and gender [1]. A graphic representation of pediatric hypotension was published in 1977 [2], and no updates have been published since then. The objective of this study was to update the graphic representation of pediatric hypotension.
Methods
We used a computerized calculation method to develop high-resolution graphics containing curves with 5,841 points each, to depict the main percentiles associated with low BP for girls from 1 to 17 years old in the 50th percentile of height. Each point represents the calculation of the polynomial equation that includes the statistical processing of the last Report on Blood Pressure in 2004 [3]. We also analyzed the effect of height on BP from the 5th to 95th percentile. Statistical functions generated by computerized program were used.
Results
Five monotonic curves of systolic BP for girls representing the 50th, 25th, 10th, 5th, and 2.275th (-2SD) percentiles were built (Figure 1). In relation to the table published by Haque and Zaritzsky [3], the Bland-Altman analysis of the published female systolic BP compared with actual update shows a mean bias of -0.61, with limits of agreement from -2.12 to 0.9 mmHg, which confirms the use of approximation of the values in the published table [3]. Considering a tolerance of 1 mmHg, the monotonic curve of adjustment for height of the SBP for girls does not need any correction in the 31.5th to 68.5th percentile of height, but needs maximal correction for the 5th percentile for height (-4.7 mmHg correction).
Update of chart for systolic blood pressure (SBP) based on the last Report on Blood Pressure in 2004 [3], for girls 1 to 17 years old (50th percentile of height). Considering a tolerance of 1 mmHg, the curve of adjustment for height of the SBP for girls does not need any correction in the in the 31.5th to 68.5th percentile of height.
Conclusion
The correction of systolic BP for height is of little significance, and this updated graphic can be used to diagnose low systolic BP for girls. Clinical studies are necessary to determine the systolic BP percentile that better represents clinically significant hypotension.
References
Shieh HH, Gilio AE, Barreira ER, Troster EJ, Ventura AMC, Goes PF, Souza DC, Sinimbu Filho JM, Bousso A: Pediatric hypotension: quantification of the differences between the two current definitions. Intensive Care Med 2012.,38(Suppl 1): S0662. doi: 10.1007/s00134-012-2683-0
Blumenthal S, et al.: Report of the Task Force on Blood Pressure Control in Children. Pediatrics 1977,59(Suppl):797.
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents: the fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents Pediatrics 2004,114(Suppl 4th Report):555-576.
Haque IU, Zaritsky ALL: Analysis of the evidence for the lower limit of systolic and mean arterial pressure in children. Pediatr Crit Care Med 2008, 8: 138-144.
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Shieh, H., Barreira, E., Bousso, A. et al. Update of the pediatric hypotension graphic adjusted for gender and height percentiles: systolic blood pressure for girls, 1 to 17 years old. Crit Care 17 (Suppl 3), P22 (2013). https://doi.org/10.1186/cc12638
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DOI: https://doi.org/10.1186/cc12638