An unambiguous definition of pediatric hypotension is still lacking: gaps between two percentile-based definitions and PALS / ATLS guidelines

Background Data are lacking to provide cutoffs for hypotension in children based on outcome studies and Pediatric Advanced Life Support (PALS) and Advanced Trauma Life Support (ATLS) definitions are based on normal populations. The goal of this study was to compare different normal population based cutoffs including 5th percentile of systolic blood pressure (P5-SBP) in children and adolescents from the German Health Examination Survey for Children and Adolescents (KiGGS), US population data (Fourth-Report) and cutoffs from PALS and ATLS guidelines. Methods P5-SBP according to age, sex and height was modelled based on standardized resting oscillometric BP measurements (12 199 children aged 3-17 years) from KiGGS 2003–2006. Additionally we applied the age-adjusted pediatric shock index in the KiGGS study. Results KiGGS-P5-SBP was on average 7 mm Hg higher than Fourth-Report-P5-SBP (5-10 mm Hg depending on age-sex-group). For children aged 3-9 years KIGGS P5-SBP at median height follows the formula 82 mm Hg + age, for age 10-17 the increase was not linear and is presented in a simplified table. PALS/ATLS thresholds were between KiGGS and Fourth-Report until age 11. The adult threshold of 90 mm Hg was reached by KiGGS P5-SBP median height at 8 years, PALS/ATLS at age 10 and Fourth-Report P5-SBP at 12 years. The pediatric shock index, which is supposed to identify severely injured children, was exceeded by 2.3% non-acutely ill KiGGS participants. Conclusions Our study shows that percentile-cutoffs vary by reference population. The 90 mm Hg cutoff for adolescents targets only those in the

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