Arch Dis Child: Value of blood pressure for detecting serious illness in children attending acute care settings in low- and middle-income countries: a multicentre observational study
Naomi Kemps et al.
https://adc.bmj.com/content/early/2026/05/04/archdischild-2025-329717
Do you routinely measure children's blood pressure? The full text of this paper concludes: 'Blood pressure should only be measured on indication, for example, in ill-appearing children presenting in shock or for follow-up in admitted patients to evaluate disease course.'
COMMENT (NPW): Although this study may be important I have reservations about its conclusion. It is very unusual for the findings of a single study to translate into a change in clinical practice, especially if the study (as in this case) is observational.
The conclusion of abstract is worded differently: 'Our results suggest that routine blood pressure measurement does not aid in the evaluation of well-appearing children attending acute care settings in LMICs'. This makes more sense to me than the full text conclusion, although it also needs further debate and evidence synthesis.
ABSTRACT
Background In children, the value of routine blood pressure measurement in first assessment at the emergency department has been questioned. This has, however, not yet been evaluated in low- and middle-income countries (LMICs) where the incidence of serious illness is high. This study assessed the predictive value of low systolic blood pressure to detect serious illness in children attending acute care settings in LMICs.
Methods This observational study is based on data from children attending three acute care settings in The Gambia and Suriname. Hypotension was defined by age-adjusted reference values according to Advanced Paediatric Life Support (APLS) and Paediatric Advanced Life Support (PALS) cut-offs. The outcome measure was a composite marker of serious illness consisting of admission or referral to a higher level of care. A logistic regression analysis was used to evaluate the association between hypotension and serious illness for each setting separately.
Results 20 185 visits from Gambia rural, 398 visits from Gambia urban and 1817 visits from Suriname were included. Hypotension was present in 8.3–17.3% of visits and serious illness in 3.9–15.7%. Hypotension was not significantly associated with serious illness in Gambia urban (ORAPLS 3.2 (0.7–10.9) and ORPALS 1.4 (0.1–7.6)) and Suriname (ORAPLS 1.3 (0.9–1.9) and ORPALS 1.7 (0.9–3.2)), and with an inverse association in Gambia rural (ORAPLS 0.6 (0.5–0.7) and ORPALS 0.9 (0.5–1.4)).
Conclusions Our results do not show a significant association between hypotension and serious illness in LMICs. Our results suggest that routine blood pressure measurement does not aid in the evaluation of well-appearing children attending acute care settings in LMICs.
Best wishes, Neil
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org