Heart rates in hospitalized children by age and body temperature.
OBJECTIVE
Heart rate (HR) is frequently used by clinicians in the hospital to assess a patient's severity of illness and make treatment decisions. We sought to develop percentiles that characterize the relationship of expected HR by age and body temperature in hospitalized children and to compare these percentiles with published references in both primary care and emergency department (ED) settings.


METHODS
Vital sign data were extracted from electronic health records of inpatients <18 years of age at 2 large freestanding children's hospitals from July 2011 to June 2012. We selected up to 10 HR-temperature measurement pairs from each admission. Measurements from 60% of patients were used to derive the percentile curves, with the remainder used for validation. We compared our upper percentiles with published references in primary care and ED settings.


RESULTS
We used 60,863 observations to derive the percentiles. Overall, an increase in body temperature of 1°C was associated with an increase of ∼ 10 beats per minute in HR, although there were variations across age and temperature ranges. For infants and young children, our upper percentiles were lower than in primary care and ED settings. For school-age children, our upper percentiles were higher.


CONCLUSIONS
We characterized expected HR by age and body temperature in hospitalized children. These percentiles differed from references in primary care and ED settings. Additional research is needed to evaluate the performance of these percentiles for the identification of children who would benefit from further evaluation or intervention for tachycardia.
Department of Pediatrics and Child Health, and The Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; The George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada; cdaymont@chrim.ca.
Carrie
C
Daymont
Division of General Pediatrics, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia Pennsylvania;
Christopher P
CP
Bonafide
Division of Hospital Medicine, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Patrick W
PW
Brady
D000293:Adolescent; D000367:Age Factors; D001831:Body Temperature; D002648:Child; D002673:Child, Hospitalized; D002675:Child, Preschool; D005260:Female; D006339:Heart Rate; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012016:Reference Values; D012189:Retrospective Studies
heart rate; hospital medicine; hospital rapid response team; sepsis; temperature; vital signs