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Deriving temperature and age appropriate heart rate centiles for children with acute infections
  1. Matthew James Thompson (matthew.thompson{at}dphpc.ox.ac.uk)
  1. University of Oxford, United Kingdom
    1. Anthony Harnden (anthony.harnden{at}dphpc.ox.ac.uk)
    1. University of Oxford, United Kingdom
      1. Rafael Perera (rafael.perera{at}dphpc.ox.ac.uk)
      1. University of Oxford, United Kingdom
        1. Richard Mayon-White (richard.mayon-white{at}dphpc.ox.ac.uk)
        1. University of Oxford, United Kingdom
          1. Lindsay Smith (lfpsmith{at}globalnet.co.uk)
          1. East Somerset Research Consortium, United Kingdom
            1. Diane McLeod (diane.mcleod{at}dphpc.ox.ac.uk)
            1. University of Oxford, United Kingdom
              1. David Mant (david.mant{at}dphpc.ox.ac.uk)
              1. Oxford, United Kingdom

                Abstract

                Objectives: To describe the reference range for heart rate in children aged 3 months -10 years presenting to primary care with self-limiting infections.

                Design: Cross-sectional study of children presenting to primary care with suspected acute infection. We measured heart rate using a pulse oximeter and axillary temperature using an electronic thermometer. We calculated centile charts of heart rates expected at given temperatures for children with self-limiting infections.

                Setting: Ten general practice surgeries and two out-of-hours centres in England.

                Participants: 1933 children presenting with suspected acute infections were recruited from in-hours GP surgeries (1050 or 54.3%) or out-of-hours centres (883 or 45.7%). After excluding children who subsequently attended hospital, and those without a final diagnosis of acute infection, 1589 children were used to create the centile charts of whom (859 or 54.1%) had upper respiratory tract infections and (215 or 13.5%). non-specific viral illness.

                Main outcome measures: Median, 75th, 90th and 97th centiles of heart rate at each temperature level.

                Results: Heart rate increased by 9.9 to 14.1 beats/min with each 1oC increment in temperature. The 50th, 75th, 90th, and 97th centiles of heart rate at each temperature level are presented graphically.

                Conclusions: Age-specific centile charts of heart rates expected at different temperatures should be used by clinicians in the initial assessment of children with acute infections. The charts will identify children who have a heart rate higher than expected for a given temperature and facilitate the interpretation of changes in heart rate on reassessment. Further research on their predictive value is needed to optimise the diagnostic utility of the centile charts.

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