A descriptive analysis of the routinely collected physiological observations of children and young people in a tertiary UK Children’s hospital

Abstract

Background As part of standard care, all CYP require routine assessment of their physiological observations. Physiological observation reference ranges have historically been based on expert opinion rather than solid evidence (Fleming et al. 2012:1011). Research is therefore required to ensure that these tools are based on robust, evidence based physiological observation thresholds, to ensure they are both sensitive and specific. Research objectives 1. To describe using summary statistical analysis, the characteristics of physiological observations by age, sex and diagnosis, of all CYP admitted to a tertiary children’s hospital in the UK, between 20142017. 2. To compare the physiological observations of CYP admitted to a tertiary children’s hospital in the UK (between 2014-2017), with standardised reference ranges from key clinical texts and guidelines. Method In this study, the researcher undertook secondary analysis of routinely collected data. The physiological observations of CYP were captured electronically as part of normal patient assessment. Sample - the physiological observations (respiratory rate, heart rate, and blood pressure) of 22,584 CYP were analysed to produce age specific centile charts for each variable. Only the discharge observation were used for the centile development to try and reflect ‘normality’. Results The vital signs of CYP in hospital appear to differ from ‘well’ CYP. APLS 6th Ed. reference ranges for respiratory rate and blood pressure poorly align to the centiles derived in this study, although the centiles for heart rate align well. Data was also interrogated to compare the respiratory rate and heart rate centiles of the study population with centiles developed in three clinical papers (Fleming et al. 2011, Bonafide et al. 2013 and O’Leary et al. 2015). Variance was demonstrated between these centiles and the study group, with most variance seen in the upper centiles. Similar to the comparison with APLS reference ranges, heart rate showed best alignment. The study group stood out as having the least aligned heart rate data – this is potentially due to outliers (who were febrile) not being excluded from the study data, which was in contrast to both the Bonafide et al. (2013) and O’Leary et al. (2015) data. Conclusion APLS reference ranges for respiratory rate and blood pressure do not appear representative of contempory inpatient CYP population. Most variance is seen when comparing the respiratory rate centiles, particularly in the younger age groups (>3yrs). Conversely, heart rate centiles demonstrate better agreement. Although four studies have now developed centiles for vital sign of CYP, evidence must be cautiously interpreted due to the heterogeneity across the studies making comparing the centiles difficult.

Date of Award	2019
Original language	English
Awarding Institution	Coventry University