A5V4d

Heart rate
Introduction
Clinical assessment of the child with fever
A specific review question was outlined for heart rate because no evidence was found for the 2007
guideline and it was known that new evidence had become available.
Heart rate is often assumed to be a useful marker of serious illness. For example, it is widely taught to
use heart rate as a marker of circulatory insufficiency in shock. 110 However, heart rate is affected by a
variety of factors (such as age, activity, anxiety, pain, body temperature) as well as the presence or
absence of serious illness. A specific search was thus undertaken to look at heart rate in the context
of serious illness.
Review question
The clinical question outlined in the scope was ’What is the predictive value of heart rate, including:
how heart rate changes with temperature
whether heart rate outside the normal range is a sign of serious illness.’
This translates into the following review question ’What is the predictive value of heart rate, including:
how heart rate changes with temperature?
whether heart rate outside the normal range detects serious illness?
whether heart rate and temperature outside normal range detects serious illness?’
Description of excluded studies
Only one study was reviewed for the 2007 guideline and this was included in the updated review. No
other studies were excluded.
Description of included studies
Six studies were identified for inclusion in this review (Brent et al., 2011; Davies et al., 2009; Hanna et
al., 2004; Thompson et al., 2009; Thompson et al, 2008; Craig et al, 2010).
Three studies were included that evaluated how heart rate changes with temperature (Davies et al.,
2009; Hanna et al., 2004; Thompson et al., 2008). The first study was a retrospective observational
study (Davies et al., 2009) that included 21,033 children. The second was a prospective study (Hanna
et al., 2004) that included 490 children who attended paediatric emergency departments, but who
were not consequently admitted to hospital. The third study was a prospective cross-sectional study
(Thompson et al., 2008) that included 1589 children who presented to primary care with a suspected
acute infection.
Three studies were included that evaluated if heart rate alone could detect serious illness (Brent et al.,
2010, Thompson et al., 2009; Craig, 2010). The Brent (2010) study included two datasets. The first
was from a cross-sectional prospective study of 1360 children presenting at a paediatric emergency
department with suspected serious bacterial infection and the second was from a case–control study
including 325 children with confirmed meningitis. The Thompson (2009) study examined 700 children
attending a paediatric assessment unit for suspected infection. The Craig (2010) study examined
12,807 children presenting at a children’s emergency department in a hospital in Australia. The study
used an elevated heart rate to detect pneumonia, urinary tract infection or bacteraemia.
One study was included that examined heart rate in conjunction with temperature (Brent et al., 2010).
Evidence profile
The evidence is presented in both narrative and GRADE format.
How heart rate changes with temperature
Three studies are reviewed in this section (see Table 5.51 for the GRADE evidence profile).
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2013 Update