Pediatric hypertension: diagnostic patterns derived from electronic health records

Goutham Rao 1 , Sara Naureckas 2 , Avisek Datta 3 , Nivedita Mohanty 2 , Victoria Bauer 4 , Roxane Padilla 5 , Sarah S. Rittner 5 , Sandra Tilmon 5  and Paul Epner 6
  • 1 Case Western Reserve University and University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106-4915, USA
  • 2 Northwestern University Feinberg School of Medicine, Chicago, IL, USA
  • 3 Research Institute, NorthShore University Health System, Evanston, IL, USA
  • 4 Ambulatory Primary Care Innovations Group, NorthShore University Health System, Evanston, IL, USA
  • 5 Alliance of Chicago, Chicago, IL, USA
  • 6 Society to Improve Diagnosis in Medicine, Chicago, IL, USA
Goutham Rao
  • Corresponding author
  • Case Western Reserve University and University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106-4915, USA
  • Email
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Sara Naureckas, Avisek Datta, Nivedita Mohanty, Victoria Bauer
  • Ambulatory Primary Care Innovations Group, NorthShore University Health System, Evanston, IL, USA
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Roxane Padilla, Sarah S. Rittner, Sandra Tilmon and Paul Epner

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.

  • 1.

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

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 8.

    AllianceChicago. http://alliancechicago.org/mission-history/. Accessed 17 August 2017.

  • 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.

  • 10.

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

  • 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.

Purchase article
Get instant unlimited access to the article.
$42.00
Log in
Already have access? Please log in.


Journal + Issues

Diagnosis aims at answering the question how diagnosis determines the quality of medical care. It focuses on how diagnosis can be advanced, how it is taught, and how and why it can fail, leading to diagnostic errors. The journal welcomes both fundamental and applied works, improvement initiatives, opinions, and debates to encourage new thinking on improving this critical aspect of healthcare quality.

Search