{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:24:52Z","timestamp":1791379492942,"version":"4.3.2"},"reference-count":34,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013,4,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE:<\/jats:title>\n                    <jats:p>To develop and validate heart and respiratory rate percentile curves for hospitalized children and compare their vital sign distributions to textbook reference ranges and pediatric early warning score (EWS) parameters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>For this cross-sectional study, we used 6 months of nurse-documented heart and respiratory rates from the electronic records of 14\u2009014 children on general medical and surgical wards at 2 tertiary-care children\u2019s hospitals. We developed percentile curves using generalized additive models for location, scale, and shape with 67% of the patients and validated the curves with the remaining 33%. We then determined the proportion of observations that deviated from textbook reference ranges and EWS parameters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>We used 116\u2009383 heart rate and 116\u2009383 respiratory rate values to develop and validate the percentile curves. Up to 54% of heart rate observations and up to 40% of respiratory rate observations in our sample were outside textbook reference ranges. Up to 38% of heart rate observations and up to 30% of respiratory rate observations in our sample would have resulted in increased EWSs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>A high proportion of vital signs among hospitalized children would be considered out of range according to existing reference ranges and pediatric EWSs. The percentiles we derived may serve as useful references for clinicians and could be used to inform the development of evidence-based vital sign parameters for physiologic monitor alarms, inpatient electronic health record vital sign alerts, medical emergency team calling criteria, and EWSs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1542\/peds.2012-2443","type":"journal-article","created":{"date-parts":[[2013,3,11]],"date-time":"2013-03-11T22:14:26Z","timestamp":1363040066000},"page":"e1150-e1157","source":"Crossref","is-referenced-by-count":195,"title":["Development of Heart and Respiratory Rate Percentile Curves for Hospitalized Children"],"prefix":"10.1542","volume":"131","author":[{"given":"Christopher P.","family":"Bonafide","sequence":"first","affiliation":[{"name":"Division of General Pediatrics, and"},{"name":"Center for Pediatric Clinical Effectiveness, The Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania;"},{"name":"Department of Pediatrics, Perelman School of Medicine, and"},{"name":"Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick W.","family":"Brady","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine,"},{"name":"James M. Anderson Center for Health Systems Excellence, and"},{"name":"Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ron","family":"Keren","sequence":"additional","affiliation":[{"name":"Division of General Pediatrics, and"},{"name":"Center for Pediatric Clinical Effectiveness, The Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania;"},{"name":"Department of Pediatrics, Perelman School of Medicine, and"},{"name":"Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick H.","family":"Conway","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine,"},{"name":"James M. Anderson Center for Health Systems Excellence, and"},{"name":"Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith","family":"Marsolo","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio;"},{"name":"Division of Biomedical Informatics, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carrie","family":"Daymont","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada; and"},{"name":"Manitoba Institute of Child Health, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2013,4,1]]},"reference":[{"issue":"2","key":"2021120903265638200_B1","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1056\/NEJMra0910926","article-title":"Rapid-response teams.","volume":"365","author":"Jones","year":"2011","journal-title":"N Engl J Med"},{"issue":"9","key":"2021120903265638200_B2","doi-asserted-by":"crossref","first-page":"2463","DOI":"10.1097\/01.CCM.0000235743.38172.6E","article-title":"Findings of the first consensus conference on medical emergency teams [published correction appears in Crit Care Med. 2006:34(12):3070].","volume":"34","author":"Devita","year":"2006","journal-title":"Crit Care Med"},{"issue":"4","key":"2021120903265638200_B3","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1016\/j.resuscitation.2009.12.008","article-title":"\u201cIdentifying the hospitalised patient in crisis\u201d\u2014a consensus conference on the afferent limb of rapid response systems.","volume":"81","author":"DeVita","year":"2010","journal-title":"Resuscitation"},{"issue":"3","key":"2021120903265638200_B4","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1097\/01.PCC.0000262947.72442.EA","article-title":"Implementation of a medical emergency team in a large pediatric teaching hospital prevents respiratory and cardiopulmonary arrests outside the intensive care unit.","volume":"8","author":"Brilli","year":"2007","journal-title":"Pediatr Crit Care Med"},{"issue":"2","key":"2021120903265638200_B5","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1001\/archpediatrics.2007.33","article-title":"Transition from a traditional code team to a medical emergency team and categorization of cardiopulmonary arrests in a children\u2019s center.","volume":"162","author":"Hunt","year":"2008","journal-title":"Arch Pediatr Adolesc Med"},{"issue":"19","key":"2021120903265638200_B6","doi-asserted-by":"crossref","first-page":"2267","DOI":"10.1001\/jama.298.19.2267","article-title":"Effect of a rapid response team on hospital-wide mortality and code rates outside the ICU in a Children\u2019s Hospital.","volume":"298","author":"Sharek","year":"2007","journal-title":"JAMA"},{"issue":"3","key":"2021120903265638200_B7","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1097\/PCC.0b013e318198b02c","article-title":"Reduction of hospital mortality and of preventable cardiac arrest and death on introduction of a pediatric medical emergency team.","volume":"10","author":"Tibballs","year":"2009","journal-title":"Pediatr Crit Care Med"},{"issue":"9477","key":"2021120903265638200_B8","doi-asserted-by":"crossref","first-page":"2091","DOI":"10.1016\/S0140-6736(05)66733-5","article-title":"Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial.","volume":"365","author":"Hillman","year":"2005","journal-title":"Lancet"},{"issue":"7","key":"2021120903265638200_B9","doi-asserted-by":"crossref","first-page":"1398","DOI":"10.1007\/s00134-004-2268-7","article-title":"Introducing Critical Care Outreach: a ward-randomised trial of phased introduction in a general hospital.","volume":"30","author":"Priestley","year":"2004","journal-title":"Intensive Care Med"},{"issue":"1","key":"2021120903265638200_B10","doi-asserted-by":"crossref","first-page":"32","DOI":"10.7748\/paed.17.1.32.s27","article-title":"Detecting and managing deterioration in children.","volume":"17","author":"Monaghan","year":"2005","journal-title":"Paediatr Nurs"},{"issue":"3","key":"2021120903265638200_B11","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.jcrc.2006.06.007","article-title":"The Pediatric Early Warning System score: a severity of illness score to predict urgent medical need in hospitalized children.","volume":"21","author":"Duncan","year":"2006","journal-title":"J Crit Care"},{"issue":"2","key":"2021120903265638200_B12","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.iccn.2005.09.003","article-title":"Promoting care for acutely ill children-development and evaluation of a paediatric early warning tool.","volume":"22","author":"Haines","year":"2006","journal-title":"Intensive Crit Care Nurs"},{"issue":"8","key":"2021120903265638200_B13","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1136\/adc.2008.142026","article-title":"Prospective cohort study to test the predictability of the Cardiff and Vale paediatric early warning system.","volume":"94","author":"Edwards","year":"2009","journal-title":"Arch Dis Child"},{"issue":"4","key":"2021120903265638200_B14","doi-asserted-by":"crossref","first-page":"R135","DOI":"10.1186\/cc7998","article-title":"Development and initial validation of the Bedside Paediatric Early Warning System score.","volume":"13","author":"Parshuram","year":"2009","journal-title":"Crit Care"},{"issue":"2","key":"2021120903265638200_B15","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1111\/j.1744-6155.2008.00178.x","article-title":"Prospective evaluation of a pediatric inpatient early warning scoring system.","volume":"14","author":"Tucker","year":"2009","journal-title":"J Spec Pediatr Nurs"},{"issue":"4","key":"2021120903265638200_B16","doi-asserted-by":"crossref","first-page":"e763","DOI":"10.1542\/peds.2009-0338","article-title":"Sensitivity of the pediatric early warning score to identify patient deterioration.","volume":"125","author":"Akre","year":"2010","journal-title":"Pediatrics"},{"issue":"4","key":"2021120903265638200_B17","doi-asserted-by":"crossref","first-page":"R184","DOI":"10.1186\/cc10337","article-title":"Multicentre validation of the bedside paediatric early warning system score: a severity of illness score to detect evolving critical illness in hospitalised children.","volume":"15","author":"Parshuram","year":"2011","journal-title":"Crit Care"},{"key":"2021120903265638200_B18","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1016\/B978-1-4377-0755-7.00062-2","article-title":"Pediatric emergencies and resuscitation","volume-title":"Nelson Textbook of Pediatrics","author":"Hartman","year":"2011","edition":"19th ed."},{"key":"2021120903265638200_B19","first-page":"585","article-title":"Pulmonology","volume-title":"The Harriet Lane Handbook","author":"Kirk","year":"2011","edition":"19th ed."},{"key":"2021120903265638200_B20","first-page":"170","article-title":"Cardiology","volume-title":"The Harriet Lane Handbook","author":"Lennox","year":"2011","edition":"19th ed."},{"key":"2021120903265638200_B21"},{"issue":"9770","key":"2021120903265638200_B22","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1016\/S0140-6736(10)62226-X","article-title":"Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a systematic review of observational studies.","volume":"377","author":"Fleming","year":"2011","journal-title":"Lancet"},{"issue":"6","key":"2021120903265638200_B23","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1016\/j.amjhyper.2005.04.004","article-title":"The impact of observer and patient factors on the occurrence of digit preference for zero in blood pressure measurement in a hypertension specialty clinic: evidence for the need of continued observation.","volume":"19","author":"Graves","year":"2006","journal-title":"Am J Hypertens"},{"key":"2021120903265638200_B24"},{"issue":"19","key":"2021120903265638200_B25","doi-asserted-by":"crossref","first-page":"3053","DOI":"10.1002\/sim.1861","article-title":"Smooth percentile curves for skew and kurtotic data modelled using the Box-Cox power exponential distribution.","volume":"23","author":"Rigby","year":"2004","journal-title":"Stat Med"},{"key":"2021120903265638200_B26","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1111\/j.1467-9876.2005.00510.x","article-title":"Generalized additive models for location, scale and shape.","volume":"54(3)","author":"Rigby","year":"2005","journal-title":"J Roy Stat Soc C Appl Stat."},{"issue":"3","key":"2021120903265638200_B27","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1191\/1471082X06st122oa","article-title":"Using the Box-Cox t distribution in GAMLSS to model skewness and kurtosis.","volume":"6","author":"Rigby","year":"2006","journal-title":"Stat Model"},{"issue":"7","key":"2021120903265638200_B28","doi-asserted-by":"crossref","DOI":"10.18637\/jss.v023.i07","article-title":"Generalized additive models for location scale and shape (GAMLSS) in R.","volume":"23","author":"Stasinopoulos","year":"2007","journal-title":"J Stat Softw"},{"key":"2021120903265638200_B29","unstructured":"WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards: Length\/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. Geneva, Switzerland: World Health Organization; 2006: www.who.int\/childgrowth\/standards\/Technical_report.pdf. Accessed April 1, 2012"},{"issue":"23","key":"2021120903265638200_B30","doi-asserted-by":"crossref","first-page":"2891","DOI":"10.1002\/sim.3667","article-title":"Estimating regional percentile curves from mixed data sources and countries.","volume":"28","author":"van Buuren","year":"2009","journal-title":"Stat Med"},{"issue":"4","key":"2021120903265638200_B31","doi-asserted-by":"crossref","first-page":"e836","DOI":"10.1542\/peds.2010-0410","article-title":"Head-circumference distribution in a large primary care network differs from CDC and WHO curves.","volume":"126","author":"Daymont","year":"2010","journal-title":"Pediatrics"},{"issue":"1","key":"2021120903265638200_B32","doi-asserted-by":"crossref","first-page":"28","DOI":"10.4037\/ajcc2010651","article-title":"Monitor alarm fatigue: standardizing use of physiological monitors and decreasing nuisance alarms.","volume":"19","author":"Graham","year":"2010","journal-title":"Am J Crit Care"},{"issue":"8","key":"2021120903265638200_B33","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1016\/j.resuscitation.2011.03.006","article-title":"Percentile-based early warning scores derived from statistical distributions of vital signs.","volume":"82","author":"Tarassenko","year":"2011","journal-title":"Resuscitation"},{"issue":"8","key":"2021120903265638200_B34","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1016\/j.resuscitation.2011.04.020","article-title":"Percentile-based Early Warning Scores derived from statistical distributions of vital signs","volume":"82","author":"Subbe","year":"2011","journal-title":"Resuscitation"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/131\/4\/e1150\/1099618\/peds_2012-2443.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/131\/4\/e1150\/1099618\/peds_2012-2443.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,9]],"date-time":"2021-12-09T13:14:02Z","timestamp":1639055642000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/131\/4\/e1150\/31913\/Development-of-Heart-and-Respiratory-Rate"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,4,1]]},"references-count":34,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2013,4,1]]},"published-print":{"date-parts":[[2013,4,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2012-2443","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,4,1]]}}}