Evaluation of the “Tilt Test” in children

• Published in: Annals of emergency medicine Vol. 16; no. 4; pp. 386 - 390
• Main Authors: Fuchs, Susan M, Jaffe, David M
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Mosby, Inc 01.04.1987; Elsevier
• Subjects: Adolescent; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Pressure; Blood Volume Determination - methods; Child; Child, Preschool; Dehydration - diagnosis; Dehydration - physiopathology; Emergencies; Emergency and intensive care: infection, septic shock; Female; Humans; Hypotension, Orthostatic - diagnosis; Hypotension, Orthostatic - physiopathology; hypovolemia, use of tilt test; Intensive care medicine; Male; Medical sciences; Posture; Pulse; tilt test, and hypovolemia; tilt test, and hypovolemia; hypovolemia, use of tilt test; Human; Arterial pressure; Arterial pulse; Hypovolemia; Child; Resuscitation
• ISSN: 0196-0644; 1097-6760
• DOI: 10.1016/S0196-0644(87)80356-6

The “tilt test” (assessment of orthostatic pulse and blood pressure) is a non-invasive screening test for acute intravascular volume loss with well-accepted utility in the emergency evaluation of adults. Its value in children has been questioned because of reports of high false-positive rates. We report a prospective study to compare “tilt test” results between children with and without clinical volume depletion in a pediatric emergency setting. Children 4 to 15 years old seeking care at an urban pediatric emergency department were eligible. Children meeting the following criteria were classified as dehydrated: an acute history of vomiting or diarrhea and a volume depletion score ⩾ 4. The control sample was selected from children with minor complaints, and a volume depletion score < 4. Blood pressure and heart rate were recorded at one-minute intervals by an automatic noninvasive blood pressure monitor for three minutes in the supine position. Subsequently, measurements were taken for two minutes in the standing position with the arm supported at heart level. Sixteen dehydrated and 21 normal children were enrolled; the groups were comparable in mean age, weight, sex, and oral temperature, but differed significantly in racial background. The mean orthostatic rise in heart rate was 29.1 beats per minute (± 10.7) in the clinically dehydrated group and 13.1 beats per minute (± 8.5) in the control group ( P < .001). There was no significant difference between the two groups with respect to the small decrease in systolic blood pressure (0.38 and 0.46 mm Hg). Two different cutoff points were used to derive criteria for a positive tilt test in children: an increase in heart rate > 20 and > 25 beats per minute. This resulted in a tilt test sensitivity of 81% and 75%, and a specificity of 81% and 95%, respectively. Five dehydrated children (and no normal children) had resting tachycardia; four were febrile, and three of these had tilt tests negative for pulse rate change that we considered to be false negatives. Our results support the use of the tilt test to assist in the diagnosis of hypovolemia in children.