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What is 'normal?' Evaluating vital signs.

PROBLEM
Vital sign (VS) assessment and monitoring are often routinely scheduled whether they are needed or not. This practice led pediatric nurse leaders to voice concerns about the frequency of VS at a National Summit for Pediatric and Adolescent Evidence-Based Practice. A search of databases yielded no direct evidence regarding frequency. However, we determined that before this question could be adequately addressed, we first needed answers to two other important questions concerning normative values for this population and what constitutes significant change in VS.


CLINICAL QUESTIONS
Among pediatric patients 1 to 5 years of age, 1) what are "normal" VS parameters, and 2) what is a significant change in VS?


METHOD
Additional searches, including a hand search, yielded five systematic reviews, one case-control study, five descriptive studies, and eight textbooks on normative values for children. Additionally, six articles on pediatric early warning signs (PEWS) were also reviewed.


FINDINGS
Systematic reviews agree that vital signs are ill-defined and are a poor indicator of physical deterioration in young children. Normative VS tables are inconsistent and sometimes contradictory. Change parameters in the PEWS literature also lacked consistency. There is scarcity of high-quality, consistent research on normative VS values for children. Additionally, there is a lack of evidence to guide the frequency of assessments and use of behavioral and physiologic indicators of decline in young hospitalized children. This points to opportunities for further research in these areas. Clinicians need VS guidelines based on research to guide their clinical decision making and interventions.