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

Beacher, D. R.; Chang, S. Z.; Rosen, J. S.; Lipkin, G. S.; McCarville, M. M.; Quadri-Sheriff, M.; Kwon, S.; Lane, J. C.; Binns, H. J.; Ariza, A. J.

J Pediatr. 2015 Apr 29; 166(5):1233-1239.e1

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.

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