Age‐based centiles for diastolic blood pressure among children in the out‐of‐hospital emergency setting

OBJECTIVE: To compare Pediatric Advanced Life Support (PALS) diastolic blood pressure (DBP) criteria to empirically derived DBP criteria for the prediction of out‐of‐hospital interventions in children. METHODS: We performed a retrospective study of pediatric (<18 years) encounters from the ESO Data Collaborative, which includes approximately 2000 Emergency Medical Services agencies in the United States. We developed age‐based centile curves for DBP using generalized additive models for location, scale, and shape. We compared the proportion of encounters with a low DBP when using empirically derived and PALS criteria and calculated their associations with the delivery of out‐of‐hospital interventions (advanced airway management, cardiopulmonary resuscitation, cardiac epinephrine, any systemic epinephrine, defibrillation, and bolus intravenous fluids). RESULTS: We included 343,129 encounters. When using PALS criteria, 155,564 (45.3%) were classified as having abnormal DBP, including 120,624 (35.2%) with high DBP and 34,940 (10.2%) with low DBP. When using empirically‐derived criteria, 18.6% had an abnormal DBP (ie, a DBP <10th or >90th centile). The accuracy of low DBP for out‐of‐hospital interventions between the two criteria was similar. CONCLUSION: PALS criteria for DBP classified a high proportion of children as having abnormal vital signs, particularly with diastolic hypertension. Empirically derived DBP thresholds more accurately predict the delivery of key out‐of‐hospital interventions. If externally validated, correlated to in‐hospital outcomes, and combined with thresholds for other vital signs, these may better predict the need for out‐of‐hospital interventions.