Recognition of elevated blood pressure in an outpatient pediatric tertiary care setting.
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.


METHODS
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.
University of Minnesota Medical School, Minneapolis, MN; Center on Obesity Management and Prevention, Stanley Manne Children's Research Institute, Chicago, IL.
Daniel R
DR
Beacher
University of Illinois College of Medicine at Chicago, Chicago, IL.
Sheila Z
SZ
Chang
Northwestern University, Evanston, IL.
Joshua S
JS
Rosen
Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
Genna S
GS
Lipkin
Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Megan M
MM
McCarville
Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Maheen
M
Quadri-Sheriff
Center on Obesity Management and Prevention, Stanley Manne Children's Research Institute, Chicago, IL.
Soyang
S
Kwon
Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Jerome C
JC
Lane
Center on Obesity Management and Prevention, Stanley Manne Children's Research Institute, Chicago, IL; Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL; Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Helen J
HJ
Binns
Center on Obesity Management and Prevention, Stanley Manne Children's Research Institute, Chicago, IL; Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL. Electronic address: aariza@luriechildrens.org.
Adolfo J
AJ
Ariza
D000293:Adolescent; D000553:Ambulatory Care / Q000458:organization & administration*; D001291:Attitude of Health Personnel; D001794:Blood Pressure; D002648:Child; D002675:Child, Preschool; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis*; D016015:Logistic Models; D008297:Male; D016347:Medical Records Systems, Computerized; D015999:Multivariate Analysis; D010045:Outpatients; D010372:Pediatrics / Q000458:organization & administration*; D012189:Retrospective Studies; D063128:Tertiary Health Care / Q000458:organization & administration*