title: Incidence and recognition of elevated triage blood pressure in the pediatric emergency department.
abstract: OBJECTIVE
  This study aimed to determine the incidence of elevated triage blood pressure (BP) in pediatric emergency patients and to evaluate its recognition by health care practitioners.
  
  
  METHODS
  This retrospective review randomly selected patients seen in a large academic pediatric emergency department for 13 months. Triage and subsequent BP measurements were recorded and categorized as normal or elevated (≥ 90th to < 95th, ≥ 95th-99th percentile plus 4 mm Hg, and ≥ 99th percentile plus 5 mm Hg). Physician recognition of elevated BP, training level, and specialty were collected. Demographic information and possible confounding variables (weight, pain, medications, and triage level) were also collected and analyzed. Exclusions included known hypertension or related conditions and those patients without a triage BP measurement.
  
  
  RESULTS
  Of the 978 charts reviewed, 907 were included for study (17.5% infants, 82.5% children 1 year and older to 18 years; 50% male, 50% female; 77% African American, 16% white, 4% Hispanic, and 3% other). Fifty-five percent (n = 497) had elevated triage BP (≥ 90th percentile) with only 1% (n = 7) recognized by practitioners as having elevated triage BP. Further, 152 (20%) of the 748 children 1 year and older to 18 years had severely elevated BP with only 5 recognized.
  
  
  CONCLUSIONS
  In this study, more than half of the patients had elevated triage BP (≥ 90th percentile), which was rarely recognized by emergency department practitioners regardless of specialty or experience. Early recognition of elevated triage BP offers opportunities for diagnosis of hypertension and related disorders but is challenging to accomplish.
authors.affiliation: Department of Emergency Medicine, University of Florida College of Medicine/Jacksonville, FL, USA.
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Ricke
authors.forename: Phyllis L
authors.initials: PL
authors.lastname: Hendry
authors.forename: Colleen
authors.initials: C
authors.lastname: Kalynych
authors.forename: Elena M
authors.initials: EM
authors.lastname: Buzaianu
authors.forename: Vivek
authors.initials: V
authors.lastname: Kumar
authors.forename: Colby
authors.initials: C
authors.lastname: Redfield
mesh_terms: D000293:Adolescent; D001794:Blood Pressure; D001795:Blood Pressure Determination / Q000592:standards; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies; D014218:Triage; D059466:White Coat Hypertension / Q000175:diagnosis*