Systolic hypertension and the response to blunt trauma in infants and children

Objectives: 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. Design: Secondary analysis of a prospective cohort. Setting: Emergency departments throughout England and Wales. Participants: 12 906 children presenting with acute blunt traumatic injury from August 1989 to September 1998. Main outcome measures: 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. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.