Novel tools for pediatric blood pressure percentile determination

Introduction: Childhood systolic and diastolic blood pressure (BP) norms vary by age, sex, and stature making interpretation of individual BP measurements challenging. Conversion to a blood pressure percentile (BPP) can assist in diagnosis and prognostication for many conditions including shock and hypertension. However, many published BPPs are only available for children >1 year, often require a stature measurement (missing at admission in up to 33% of electronic health records per prior reports), and only provide percentiles above the median. To fill these gaps, we developed an R package (‘pedbp’) and web application using BP data from prior publications to facilitate rapid calculation of BPP estimates. Methods: We performed a literature search for pediatric population BP measurements published 1981-2022. We extracted published BP means and standard deviations and percentiles for systolic and diastolic BP measurements for each cohort: age, sex, and stature (if applicable). We used this data to define a Gaussian for systolic and diastolic BPPs for each cohort (with separate distributions for cohorts of unknown stature). Results: The pedbp package (http://cran.r-project.org/package=pedbp) in the R programming language makes obtaining a BPP for a single BP measurement possible with a single function call. For example, the BPP for a BP of 100/60 in a 44-month-old male with length 105 cm is found via: “p_bp(q_sbp = 100, q_dbp = 60, age = 44, male = 1, height = 105)” which returns a value of 0.7086 (70.86th percentile) for SBP, and 0.8486 (84.86th percentile) for DBP. Batch processing (conversion to BPPs for >1 observation) is also supported. We created an intuitive web version of this method for individual and batch BPP processing at https://dewittpe.shinyapps.io/pedbp/. A BPP for an individual BP measurement can be obtained by entering patient data (BP, sex, and stature [if known]) into corresponding text boxes. Batch processing is accomplished by uploading a csv file with results then provided as a downloadable csv file. Conclusions: The pedbp package and web tool provide BPPs for children of all ages regardless of stature measurement availability. Such tools could facilitate identification of children with shock or hypertension. A potential limitation is assumption of Gaussian BP distributions.