title: Safety analysis of proposed data-driven physiologic alarm parameters for hospitalized children.
abstract: Modification of alarm limits is one approach to mitigating alarm fatigue. We aimed to create and validate heart rate (HR) and respiratory rate (RR) percentiles for hospitalized children, and analyze the safety of replacing current vital sign reference ranges with proposed data-driven, age-stratified 5th and 95th percentile values.
  
  
  
  In this retrospective cross-sectional study, nurse-charted HR and RR data from a training set of 7202 hospitalized children were used to develop percentile tables. We compared 5th and 95th percentile values with currently accepted reference ranges in a validation set of 2287 patients. We analyzed 148 rapid response team (RRT) and cardiorespiratory arrest (CRA) events over a 12-month period, using HR and RR values in the 12 hours prior to the event, to determine the proportion of patients with out-of-range vitals based upon reference versus data-driven limits.
  
  
  
  There were 24,045 (55.6%) fewer out-of-range measurements using data-driven vital sign limits. Overall, 144/148 RRT and CRA patients had out-of-range HR or RR values preceding the event using current limits, and 138/148 were abnormal using data-driven limits. Chart review of RRT and CRA patients with abnormal HR and RR per current limits considered normal by data-driven limits revealed that clinical status change was identified by other vital sign abnormalities or clinical context.
  
  
  
  A large proportion of vital signs in hospitalized children are outside presently used norms. Safety evaluation of data-driven limits suggests they are as safe as those currently used. Implementation of these parameters in physiologic monitors may mitigate alarm fatigue. Journal of Hospital Medicine 2015;11:817-823. © 2015 Society of Hospital Medicine.
authors.affiliation: Division of Pediatric Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California.|Department of Clinical Informatics, Stanford Children's Health, Stanford, California.
authors.forename: Veena V
authors.initials: VV
authors.lastname: Goel
authors.affiliation: Biomedical Informatics Training Program, Stanford University, Stanford, California.
authors.forename: Sarah F
authors.initials: SF
authors.lastname: Poole
authors.affiliation: Department of Pediatrics, University of California San Diego School of Medicine, San Diego, California.|Department of Biomedical Informatics, University of California San Diego School of Medicine, San Diego, California.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Longhurst
authors.affiliation: Division of Pediatric Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California.|Performance Improvement Department, Stanford Children's Health, Stanford, California.
authors.forename: Terry S
authors.initials: TS
authors.lastname: Platchek
authors.affiliation: Department of Clinical Informatics, Stanford Children's Health, Stanford, California.|Division of Pediatric Critical Care, Department of Pediatrics, Stanford University School of Medicine, Stanford, California.
authors.forename: Natalie M
authors.initials: NM
authors.lastname: Pageler
authors.affiliation: Division of Pediatric Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California.|Center for Quality and Clinical Effectiveness, Stanford Children's Health, Stanford, California.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Sharek
authors.affiliation: Department of Clinical Informatics, Stanford Children's Health, Stanford, California.|Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Palma
mesh_terms: D000293:Adolescent; D002648:Child; D002673:Child, Hospitalized; D002675:Child, Preschool; D056902:Clinical Alarms / Q000592:standards*; D003430:Cross-Sectional Studies; D006323:Heart Arrest / Q000517:prevention & control; D006339:Heart Rate; D057209:Hospital Rapid Response Team; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010372:Pediatrics; D012016:Reference Values; D056152:Respiratory Rate; D012189:Retrospective Studies; D017751:Safety Management / Q000379:methods*; D055986:Vital Signs