Accessible Unlicensed Requires Authentication Published by De Gruyter August 21, 2018

Pediatric hypertension: diagnostic patterns derived from electronic health records

Goutham Rao, Sara Naureckas, Avisek Datta, Nivedita Mohanty, Victoria Bauer, Roxane Padilla, Sarah S. Rittner, Sandra Tilmon and Paul Epner
From the journal Diagnosis

Abstract

Background

Pediatric hypertension is a serious problem associated with target organ damage in children and an increased risk for adult hypertension. African-American and Latino children are disproportionately affected. Unfortunately, due to a variety of factors, including the complexity of blood pressure (BP) standards, pediatric hypertension is undiagnosed in the majority of cases. We sought to identify factors associated with correct diagnosis and to better understand diagnosis of hypertension by studying the diagnostic paths of a small number of children.

Methods

Data were extracted from electronic health records (EHRs) of children who met criteria for hypertension. Logistic regression was used to identify factors associated with correct diagnosis. Diagnostic paths for 20 diagnosed children were extracted through chart review and analyzed.

Results

Among 1478 hypertensive children, only 85 were diagnosed (6.1%). Age ≥12 compared to age ≤6 was associated with correct diagnosis [odds ratio (OR) of 1.96, 95% confidence interval (CI) (1.16, 3.32)]. Diagnostic paths revealed that primary care providers (PCPs) make the diagnosis based on multiple readings over time and order laboratory tests appropriately.

Conclusions

Hypertension is missed in a large proportion of all children. Effective, systematic approaches to diagnosis are necessary.


Corresponding author: Goutham Rao, MD, Case Western Reserve University and University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106-4915, USA

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: Agency for Health Care Research and Quality, R21 HS024100.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

References

1. Rao G. Diagnosis, epidemiology, and management of hypertension in children. Pediatrics 2016;138:e20153616.Search in Google Scholar

2. Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 2017;140:e20171904.Search in Google Scholar

3. Aliazardeh B, Meaney C, Moineddin R, White D, Birken C, Parkin P, et al. Hypertension screening and follow-up in children and adolescents in a Canadian primary care population sample: a retrospective cohort study. CMAJ Open 2016;4:E230–5.Search in Google Scholar

4. Chen L, Simonsen N, Liu L. Racial differences in pediatric hypertension in relation to birth weight and body size in the United States. PLoS One 2015;10:e0132606.Search in Google Scholar

5. Rao G, Epner P, Bauer V, Solomonides A, Newman-Toker DE. Identifying and analyzing diagnostic paths: a new approach for studying diagnostic practices. Diagnosis 2017;4:67–72.Search in Google Scholar

6. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics 2011;128(Suppl 5):S213–56.Search in Google Scholar

7. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004;114(2 Suppl 4th Report):555–76.Search in Google Scholar

8. AllianceChicago. . Accessed 17 August 2017.Search in Google Scholar

9. World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. J Am Med Assoc 2013;310:2191–4.Search in Google Scholar

10. Bello JK, Mohanty N, Bauer V, Rittner SS, Rao G. Pediatric hypertension: provider perspectives. Glob Pediatr Health 2017;4:2333794X17712637.Search in Google Scholar

11. Dwyer T, Sun C, Magnussen CG, Raitakari OT, Schork NJ, Venn A, et al. Cohort profile: the international childhood cardiovascular cohort (i3C) consortium. Int J Epidemiol 2013;42:86–96.Search in Google Scholar

Received: 2018-04-09
Accepted: 2018-07-25
Published Online: 2018-08-21
Published in Print: 2018-09-25

©2018 Walter de Gruyter GmbH, Berlin/Boston