Abstract
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.
