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J Pediatr. 2015 May;166(5):1233-1239.e1. doi: 10.1016/j.jpeds.2015.02.006.

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

Author information

1
University of Minnesota Medical School, Minneapolis, MN; Center on Obesity Management and Prevention, Stanley Manne Children's Research Institute, Chicago, IL.
2
University of Illinois College of Medicine at Chicago, Chicago, IL.
3
Northwestern University, Evanston, IL.
4
Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
5
Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL.
6
Center on Obesity Management and Prevention, Stanley Manne Children's Research Institute, Chicago, IL.
7
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.
8
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.

Abstract

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.

STUDY DESIGN:

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.

PMID:
25919733
DOI:
10.1016/j.jpeds.2015.02.006
[Indexed for MEDLINE]

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