Distributions and Behavior of Vital Signs in Critically Ill Children by Admission Diagnosis*

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Abstract

Objectives:

Define the distributions of heart rate and intraarterial blood pressure in children at admission to an ICU based on admission diagnosis and examine trends in these physiologic signs over 72 hours from admission (or to discharge if earlier).

Design:

A retrospective analysis of continuously acquired signals.

Setting:

A quaternary and primary referral children’s hospital with a general PICU and cardiac critical care unit.

Patients:

One thousand two hundred eighty-nine patients less than 18 years old were analyzed. Data from individual patient admissions were divided into 19 groups by primary admission diagnosis or surgical procedure.

Interventions:

None.

Measurement and Main Results:

Distributions at admission are dependent on patient age and admission diagnosis (p < 10–6). Heart rate decreases over time, whereas arterial blood pressure is relatively stable, with differences seen in the directions and magnitude of these trends when analyzed by diagnosis group (p < 10–6). Multiple linear regression analysis shows that patient age, diagnosis group, and physiologic vital sign value at admission explain 50–63% of the variation observed for that physiologic signal at 72 hours (or at discharge if earlier) with admission value having the greatest influence. Furthermore, the variance of either heart rate or arterial blood pressure for the individual patient is smaller than the variance measured at the level of the group of patients with the same diagnosis.

Conclusions:

This is the first study reporting distributions of continuously measured physiologic variables and trends in their behavior according to admission diagnosis in critically ill children. Differences detected between and within diagnostic groups may aid in earlier recognition of outliers as well as allowing refinement of patient monitoring strategies.

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