The Value of Routine Blood Pressure Measurement in Children Presenting to the Emergency Department with Nonurgent Problems

Objective

Blood pressure (BP) is measured at triage in most emergency departments (EDs). We aimed to determine the value of triage BP in diagnosing hypotension and true hypertension in children age ≥3 years presenting with nonurgent problems.

Study design

In this prospective study, eligible children underwent automated BP measurement at triage. If BP was elevated, then the measurement was repeated manually. Children with a high manual BP were followed. True hypertension was defined as a manual BP >95th percentile for sex, age, and height measured on 3 occasions.

Results

Automated triage BP was measured in 549 children (53.4% male; mean age, 9.4 ± 4.3 years) and was found to be elevated in 144 of them (26%). No child was hypotensive. Among the 495 patients with complete follow-up, the specificity and positive predictive value (PPV) of elevated triage BP in diagnosing true hypertension were 81.8% and 0%, respectively. A sensitivity analysis including those with incomplete follow-up, in which the population prevalence of true hypertension was assumed to be 1% to 2%, resulted in a specificity of 74.5% to 75.3% and a PPV of 3.8% to 7.5%.

Conclusions

The yield of measuring BP at triage in children with nonurgent problems appears to be extremely low.

Abbreviations: BP, Blood pressure, CI, Confidence interval, CTAS, Canadian Triage Acuity Scale, ED, Emergency department, NHBPEP, National High Blood Pressure Education Program, PPV, Positive predictive value