Systolic hypertension and the response to blunt trauma in infants and children.
OBJECTIVE
To describe age-related systolic blood pressures and pulse rates in children following blunt injury. To compare these variables with standard reference values for uninjured children at rest and with reference ranges from the Advanced Paediatric Life Support (APLS) guidelines.


METHODS
Secondary analysis of a prospective cohort.


METHODS
Emergency departments throughout England and Wales.


METHODS
12906 children presenting with acute blunt traumatic injury from August 1989 to September 1998.


METHODS
Systolic blood pressure and pulse rate on arrival.


RESULTS
Injured children had higher systolic blood pressures than the standard quoted 'norms'. Standard reference values of systolic blood pressure for children at rest always appeared below the 50th percentile for our cohort of injured children (range 7th-27th percentiles). Pulse rates for children at rest were always towards the mid-range for injured children (range 41st-54th percentiles). These results appeared unrelated to injury severity. Age related APLS reference ranges for systolic blood pressure and pulse rate resembled the standard reference values for uninjured children at rest.


CONCLUSIONS
Injured children have a relative systolic hypertension compared with children at rest. Pulse rates in the two groups are comparable. Following injury, children with apparently 'normal' age-specific systolic blood pressures on arrival in the Emergency Department are relatively hypotensive and should be carefully assessed.
MRC Trauma Group, Stopford Building, University of Manchester, Oxford Road, M13 9PT, Manchester, UK. paul.m.dark@man.ac.uk
Paul
P
Dark
Maralyn
M
Woodford
Andy
A
Vail
Kevin
K
Mackway-Jones
David
D
Yates
Fiona
F
Lecky
D000293:Adolescent; D001794:Blood Pressure; D002648:Child; D002675:Child, Preschool; D004630:Emergencies; D006801:Humans; D006973:Hypertension / Q000209:etiology*; D007223:Infant; D007231:Infant, Newborn; D011446:Prospective Studies; D011674:Pulse; D012016:Reference Values; D014949:Wounds, Nonpenetrating / Q000150:complications*