Developing Orthostatic Measurement Guidelines for a Pediatric Emergency Department

2.50
Hdl Handle:
http://hdl.handle.net/10755/198301
Title:
Developing Orthostatic Measurement Guidelines for a Pediatric Emergency Department
Abstract:
[ENA Annual Conference 2011 - Research Presentation]Developing Orthostatic Measurement Guidelines for a Pediatric Emergency Department

Purpose: Inconsistencies in the collection of orthostatic measurements among caregivers in the emergency department may lead emergency physicians and nurse practitioners to make treatment decisions and diagnoses based on invalid data. A review of the literature reflected a lack of published guidelines/research studies to make practice recommendations for orthostatic vital sign assessment in children. The purpose of this study was to (1) determine
the length of time for a generally healthy child’s heart rate and blood pressure to return to within 10% of baseline and (2) make practice recommendations for the collection of orthostatic vital signs in pediatric patients seeking emergency care.

Design: A non-experimental two-phase design.

Setting: Data were collected in an urban, teaching, pediatric medical center in the Midwest U.S.

Participants/Subjects: A convenience sample of participants aged 9 to 17 years, with a triage acuity of 4 or 5 per the Emergency Severity Index, and normal vital signs for age were recruited. A power analysis yielded the need for 37 participants per phase. The study was granted expedited approval by the Institutional Review Board.

Methods: Phase 1 participants lay supine x5 minutes. Baseline heart rate was recorded. The participants then sat upright and heart rate was measured every 30 seconds x5 minutes. Time between measures was monitored using a stopwatch. Procedures were repeated with participants in the standing position. The minimum time required for sitting and standing heart rates to return to within 10% of baseline heart rate were identified. The mean time for each position was determined. The greater of the times was used for Phase 2 procedures. Phase 2 participants lay supine for 5 minutes. Baseline heart rate and blood pressure were recorded. The participants then sat upright and vital signs were measured at 150 seconds and repeated every 60 seconds x4 measures. Procedures were repeated with participants in the standing position. Data collection for Phase 2 is still in progress. The preliminary mean time required for sitting and standing vital signs to return to within 10% of baseline vital signs were identified.

Results/Outcomes: The mean time for Phase 1 heart rates (n=37) to return to within 10% of baseline was 50.3 seconds while sitting and 133.0 seconds while standing. The time of 150 seconds was chosen for Phase 2. Preliminary data for Phase 2 heart rates and blood pressures (n=19) to return to within 10% of baseline was 172.1 seconds while sitting and 270.0 seconds while standing.

Implications: The time required for vital signs to return to normal was shorter when participants were sitting (2.9 minutes) compared to standing (4.5 minutes). It may be desirable to record orthostatic vital signs for a variable time based on position (sitting vs. standing). For ill children who are not able to stand for 4.5 minutes, it may be necessary to consider clinical signs other than orthostatic vital signs to determine that a pediatric emergency patient is orthostatic. Further research is needed to correlate clinical assessment with vital sign data.


Repository Posting Date:
21-Dec-2011
Date of Publication:
21-Dec-2011

Full metadata record

DC FieldValue Language
dc.titleDeveloping Orthostatic Measurement Guidelines for a Pediatric Emergency Departmenten_GB
dc.identifier.urihttp://hdl.handle.net/10755/198301-
dc.description.abstract[ENA Annual Conference 2011 - Research Presentation]Developing Orthostatic Measurement Guidelines for a Pediatric Emergency Department<br/><br/>Purpose: Inconsistencies in the collection of orthostatic measurements among caregivers in the emergency department may lead emergency physicians and nurse practitioners to make treatment decisions and diagnoses based on invalid data. A review of the literature reflected a lack of published guidelines/research studies to make practice recommendations for orthostatic vital sign assessment in children. The purpose of this study was to (1) determine <br/>the length of time for a generally healthy child’s heart rate and blood pressure to return to within 10% of baseline and (2) make practice recommendations for the collection of orthostatic vital signs in pediatric patients seeking emergency care. <br/> <br/>Design: A non-experimental two-phase design. <br/><br/>Setting: Data were collected in an urban, teaching, pediatric medical center in the Midwest U.S. <br/><br/>Participants/Subjects: A convenience sample of participants aged 9 to 17 years, with a triage acuity of 4 or 5 per the Emergency Severity Index, and normal vital signs for age were recruited. A power analysis yielded the need for 37 participants per phase. The study was granted expedited approval by the Institutional Review Board. <br/><br/>Methods: Phase 1 participants lay supine x5 minutes. Baseline heart rate was recorded. The participants then sat upright and heart rate was measured every 30 seconds x5 minutes. Time between measures was monitored using a stopwatch. Procedures were repeated with participants in the standing position. The minimum time required for sitting and standing heart rates to return to within 10% of baseline heart rate were identified. The mean time for each position was determined. The greater of the times was used for Phase 2 procedures. Phase 2 participants lay supine for 5 minutes. Baseline heart rate and blood pressure were recorded. The participants then sat upright and vital signs were measured at 150 seconds and repeated every 60 seconds x4 measures. Procedures were repeated with participants in the standing position. Data collection for Phase 2 is still in progress. The preliminary mean time required for sitting and standing vital signs to return to within 10% of baseline vital signs were identified. <br/><br/>Results/Outcomes: The mean time for Phase 1 heart rates (n=37) to return to within 10% of baseline was 50.3 seconds while sitting and 133.0 seconds while standing. The time of 150 seconds was chosen for Phase 2. Preliminary data for Phase 2 heart rates and blood pressures (n=19) to return to within 10% of baseline was 172.1 seconds while sitting and 270.0 seconds while standing. <br/><br/>Implications: The time required for vital signs to return to normal was shorter when participants were sitting (2.9 minutes) compared to standing (4.5 minutes). It may be desirable to record orthostatic vital signs for a variable time based on position (sitting vs. standing). For ill children who are not able to stand for 4.5 minutes, it may be necessary to consider clinical signs other than orthostatic vital signs to determine that a pediatric emergency patient is orthostatic. Further research is needed to correlate clinical assessment with vital sign data. <br/><br/><br/>en_GB
dc.date.available2011-12-21T12:45:24Z-
dc.date.issued2011-12-21T12:45:24Z-
dc.date.accessioned2011-12-21T12:45:24Z-
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