Unrecognized elevated blood pressure in the 3-18 year old population in the primary care setting

Abstract

Objective – This study was done to assess the incidence of missed elevated blood pressure readings at two large outpatient clinics.

Methods – We randomly selected 250 charts from all pediatric well child visits seen at the two sites during 2014. Recognized elevated blood pressure was the primary outcome. We reviewed the charts to determine if systolic and/or diastolic blood pressure was greater than the 90th percentile for age, gender and height or greater than 120/80 mmHg in patients without a previous history of elevated blood pressure. The charts were then reviewed to see if the practitioners in any way recognized the elevated blood pressure reading, either by repeating the reading, a clinic note documenting the high reading, a plan to recheck in the future, relevant lab work, imaging, or a referral to a pediatric cardiologist or nephrologist.

Results – There were 72 (28.8%) children with elevated blood pressure readings. Twenty nine (40.3%) of these children were recognized as having elevated readings based on the criteria listed above. Twelve of these 29 children had other interventions taken. Forty three of these 72 children (59.7%) were not recognized and no intervention was taken.

Conclusion – Almost 60% of children with elevated blood pressure readings taken as part of the well child visit were not recognized in provider documentation. Practitioners should be aware of this common pediatric diagnostic error. Appropriate measures such as training, use of a blood pressure simplified charts, or electronic alerts should be taken to reduce the amount of missed diagnoses.