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Blood pressure is a simple physiological measure routinely estimated in many paediatric clinical environments. The recommended frequency and requirement for this measure in children is debatable, particularly in casualty departments. However the rising burden to healthcare systems from hypertension should perhaps be used to review current practice.1
One thousand and six consecutive patient records from a district general hospital in west London from May to August 2004 were audited retrospectively. Blood pressure was measured in 9% of those 16 years or younger. By contrast aural temperature and manually estimated pulse rates were recorded in 91% of the group. Age was the largest single determinant for measurement (p < 0.001); triage priority, arrival time, and presenting complaint had lower impacts. Only 32% of children with a high priority triage had a measure of blood pressure. Appropriate follow up of abnormal results was patchy; 14% of raised blood pressures documented in casualty received no follow up or repeat measure. Interviews with staff indicated that there was no perceived need to check blood pressure unless specific medical directions were received. Equipment and appropriate age related normal charts were readily available and did not limit the service.
Although no evidence supports population based blood pressure screening in children, studies have suggested advantages to the measurement of blood pressure in the hospital setting.2–4 This strategy identifies hypertension early, particularly in teenagers, who are infrequent attendees in general practice.5 In urban British populations a hospital casualty is frequently their sole point of contact with health services (local audit results).
Following the audit period in this centre two cases of essential hypertension were subsequently identified in children aged 14 and 16 years. Neither had blood pressure measured on earlier visits to casualty. As documented recently the global burden of hypertension is likely to increase.5 While A&E departments are not designed to carry out primary prevention, the valuable opportunity to prevent disease and improve outcomes with a simple measurement should not be overlooked.
Competing interests: none declared
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