Recognition of elevated blood pressure in an outpatient pediatric tertiary care setting. J Pediatr 2015 May;166(5):1233-1239.e1
Date
04/29/2015Pubmed ID
25919733DOI
10.1016/j.jpeds.2015.02.006Scopus ID
2-s2.0-84928784054 (requires institutional sign-in at Scopus site) 15 CitationsAbstract
OBJECTIVE: To assess the prevalence of elevated blood pressure (BP) and its identification among outpatients at a pediatric tertiary care hospital and to assess clinician attitudes towards BP management.
STUDY DESIGN: A retrospective review was undertaken of electronic medical record data of visits over the course of 1 year to 10 subspecialty divisions and 3 primary care services at an urban tertiary care hospital. Interviews of division/service representatives and a clinician survey on perceived role on BP care, practices, and protocols related to BP management were conducted. Elevated BP was defined as ≥90th percentile (using US references); identification of elevated BP was defined as the presence of appropriate codes in the problem list or visit diagnoses.
RESULTS: Among 29,000 patients (ages 2-17 years), 70% (those with ≥1 BP measurement) were analyzed. Patients were as follows: 50% male; 42% white, 31% Hispanic, 16% black, 5% Asian, and 5% other/missing; 52% had Medicaid insurance. A total of 64% had normal BPs, 33% had 1-2 elevated BP measurements, and 3% had ≥3 elevated BP measurements. Among those with ≥3 elevated BP measurements, the median frequency of identification by division/service was 17%; the greatest identification was for Kidney Diseases (67%), Wellness & Weight Management (60%), and Cardiology (33%). Among patients with ≥3 elevated BP measurements, 21% were identified vs 7% identified among those with 1-2 increased measurements (P<.001). All clinician survey respondents perceived self-responsibility for identification of elevated BP, but opinions varied for their role in the management of elevated BP.
CONCLUSIONS: The identification of patients with elevated BP measurements was low. Strategies to increase the identification of elevated BPs in outpatient tertiary care settings are needed.
Author List
Beacher DR, Chang SZ, Rosen JS, Lipkin GS, McCarville MM, Quadri-Sheriff M, Kwon S, Lane JC, Binns HJ, Ariza AJAuthor
Daniel R. Beacher MD Assistant Professor in the Pediatrics department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAmbulatory Care
Attitude of Health Personnel
Blood Pressure
Child
Child, Preschool
Electronic Health Records
Female
Humans
Hypertension
Logistic Models
Male
Medical Records Systems, Computerized
Multivariate Analysis
Outpatients
Pediatrics
Retrospective Studies
Tertiary Healthcare
