Towards Evidence-Based Vital Sign Reference Ranges: Centile Charts from Discharge Data in a UK Paediatric Hospital

Background There is currently no consensus as to what constitutes acceptable vital signs for paediatric patients whilst in hospital. Aims To develop age‐specific centile charts for respiratory rate, heart rate and systolic blood pressure at hospital discharge using routinely collected data from a single UK tertiary paediatric centre, and to evaluate their alignment with existing international reference ranges to inform clinical decision‐making. Study Design A cross‐sectional study at a large tertiary paediatric hospital in the United Kingdom. Participants included CYP aged 0–19 years old at hospital discharge who had been admitted to paediatric inpatient care due to a range of illness/injury between 2014 and 2019. Routinely collected respiratory rate, heart rate and blood pressure observations were described and centile charts generated using Quantile restricted cubic splines regression. Results The sample included 66 356 admission episodes. New centile charts for vital signs are presented. Advanced Paediatric Life Support (APLS, 6th Ed.) reference ranges for respiratory rate and blood pressure are poorly aligned to the centiles derived in this study although the centiles for heart rate align well. Variance was also demonstrated between the study centiles and those from the clinical papers, with the greatest differences seen in the upper centiles. Conclusion This is the first‐time physiological observations of CYP in a UK Children's hospital have been described and centile charts developed. Relevance to Clinical Practice Current widely used reference ranges, especially those for Heart Rate and Respiratory Rate, may not fit for purpose when evaluating whether the vital signs of a child are normal or otherwise.