ESPN 50th Annual Meeting

ESPN 2017


 
Novel Hypertension Diagnostic Score in Children
MOSTAFA ELBABA 1

1- WEILL CORNELL MEDICAL COLLEGE IN QATAR
 
Introduction:

Accidental discovery of high blood pressure in children usually requires unnecessary consultation, admission and investigation. Most of accidently measured high blood pressure in the clinics or emergency is falsely labelled as “hypertension”. Reactive or “white coat hypertension” is the most common cause of that medical staff and family worry. Ambulatory blood pressure monitoring is complex and expensive method to confirm this phenomenon. We invented a novel valid and reliable diagnostic score to use mainly for the newly discovered high blood pressure. This score is considered a simple, effective and rapid tool to avoid the unnecessary work-up and to objectively decide the next action.     

 

Material and methods:

 The diagnostic score is composed of 10 items with grades for each item 1, 2 or 3. The total minimum score is 10 and the maximum is 30. Score of 12 or less exclude the hypertension and requires no action needed. Score of 25 or more diagnose hypertension and requires consultation, work-up and treatment. Score from 13 to 24 needs monitoring (score 20-24) or reassessment after 48 hours (score 13-19). The score is used prospectively in 30 children on their first consultation and or referral for high blood pressure reading (considering hypertension) and then validated to the final diagnosis to confirm or to rule out pediatric hypertension and its management.

Results:

 The majority of the children (56.6%) have transient or false hypertension and they scored less than 13 with a mean10.9 ±1. Only 16.6% scored 25 or above (mean 26.4 ± 1.3) and those are considered as hypertensive by the scoring system. 26.6% scored between 13 and 24; the majority of those (75%) are between 13 and 18 and 25% are between 19 and 22. Data is revalidated within 7 days to evaluate and compare the score to the final confirmation or exclusion of hypertension. Results showed 100% of the children scored 25 or above were diagnosed as hypertensive 80% started on medication. 88% of the children scored 12 or less (and one extra child was missed) have normal blood pressure started from the second or third day and confirmed on follow up outpatient clinic visit. 37.5% of the remaining group (score 13-24) had persistently high blood pressure on monitoring and follow up.    

Conclusions:

 The novel pediatric systemic hypertension diagnostic score showed a significant accuracy validity and reliability for the diagnosis and for the recommended further action. Because it is simple, cheap, fast, accurate and reliable, we recommend its mass use in practice at least as a screening tool to select the children require further work-up or management. Larger multicenter study is needed to give more evidence for this new scoring system.