{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T15:43:17Z","timestamp":1770133397513,"version":"3.49.0"},"reference-count":18,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIH","award":["R01NS1331142"],"award-info":[{"award-number":["R01NS1331142"]}]},{"name":"NIH","award":["R01NS122119"],"award-info":[{"award-number":["R01NS122119"]}]},{"name":"computational resources provided by the BioHPC supercomputing facility located in the Lyda Hill Department of Bioinformatics, UT Southwestern Medical Center, TX"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Information"],"abstract":"<jats:p>Routine Electronic Health Record (EHR) blood pressure charting under-samples dynamic physiology, risking missed hemodynamic instability. This study quantifies how EHR-like down-sampling changes the detection and burden of hypo- and hypertension versus continuous monitoring and articulates the consequences for clinical decision support and machine learning label quality. We retrospectively analyzed 78 ECMO-supported pediatric patients (2019\u20132023). The continuous mean arterial pressure (MAP) captured every 5 s was resampled at intervals from 5 s to 1 h. We screened for 3 min windows of hypotension or hypertension at 10th\/90th age-normed thresholds, comparing the per-patient event frequency and burden with EHR-derived recordings. At 10th\/90th thresholds, hypotension events fell from 13,936 (5 s) to 3803 (15 min; \u221272.7%); the EHR captured 3471. Hypertension events dropped from 1573 to 410 (\u221273.9%); the EHR registered 1587. The EHR data overstated hypertension burden, indicating preferential documentation during prolonged instability while missing brief excursions. Standard EHR sampling significantly under-reports blood pressure derangements in pediatric ECMO. This underreporting of brief events may limit the accuracy of clinical decision support tools and machine learning algorithms in high-acuity patients. High-frequency data acquisition improves event capture and should be prioritized for clinical decision support and machine learning development.<\/jats:p>","DOI":"10.3390\/info17020135","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T09:00:33Z","timestamp":1770022833000},"page":"135","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["EHR Sampling Interval Bias Detection and Burden of Blood Pressure Excursions: Implications for Clinical Decision Support and Model Validity in Pediatric ECMO"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8873-6482","authenticated-orcid":false,"given":"Neel","family":"Shah","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Washington University in St. Louis, 660 S. Euclid Ave., St. Louis, MO 63130, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7423-6521","authenticated-orcid":false,"given":"Ethan","family":"Sanford","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA"},{"name":"Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9488-944X","authenticated-orcid":false,"given":"David R.","family":"Busch","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA"},{"name":"Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA"},{"name":"Department of Biomedical Engineering, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8562-9840","authenticated-orcid":false,"given":"Ranveer","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Computer Science, University of Texas at Dallas, Richardson, TX 75080, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saurabh","family":"Mathur","sequence":"additional","affiliation":[{"name":"Department of Computer Science, University of Texas at Dallas, Richardson, TX 75080, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5992-1942","authenticated-orcid":false,"given":"Jayesh","family":"Sharma","sequence":"additional","affiliation":[{"name":"The Anne Burnett Marion School of Medicine, Texas Christian University, Fort Worth, TX 76104, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip","family":"Reeder","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2849-2126","authenticated-orcid":false,"given":"Sriraam","family":"Natarajan","sequence":"additional","affiliation":[{"name":"Department of Computer Science, University of Texas at Dallas, Richardson, TX 75080, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7676-1346","authenticated-orcid":false,"given":"Lakshmi","family":"Raman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e1021","DOI":"10.1097\/CCM.0000000000001862","article-title":"Errors, omissions, and outliers in hourly vital signs measurements in intensive care","volume":"44","author":"Maslove","year":"2016","journal-title":"Crit. 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