Mean arterial pressure for children in US emergency department and prehospital settings

Objectives To externally validate previously reported centile curves for the mean arterial pressure (MAP) on paediatric acute care samples; derive centile curves for paediatric MAP in an acute care population and evaluate the association of age-adjusted MAP with prehospital and in-hospital outcomes. Design Retrospective observational study. Setting (1) Critical care transport service, (2) multiagency emergency medical services (EMS)and (3) multicentre paediatric emergency department datasets. Patients Paediatric (<18 years) prehospital critical care transports, EMSs, and ED encounters. Intervention(s) None. Main outcome measure Centile for mean arterial pressure. Results We included 4784 critical care transports, 4 221 048 ED encounters and 529 475 EMS encounters. Among critical care transports, the intraclass correlation between calculated and oscillometric MAP was 0.996 (95% CI 0.969 to 0.999). Using previously published MAP criteria in the ED sample, 0.1% of encounters fell below the 5th centile, whereas 32.2% were above the 90th centile and 17.7% above the 95th centile; in the EMS sample, 0.6% were below the 5th centile, whereas 55.7% were above the 90th centile and 41.0% above the 95th centile. MAP centiles aligned well with internal validation but were less accurate in the EMS sample, where 16.9% of neonates had a MAP below the 5th centile. Lower MAP was associated with increased mortality, vasoactive use and intravenous fluid use. Conclusion We describe age-specific reference distributions for paediatric MAP across a large contemporary clinical population. These findings offer a framework for interpreting an individual child’s MAP and may assist in establishing clinical norms and prediction modelling applications.