Effect of Diurnal Variation of Heart Rate and Respiratory Rate on Activation of Rapid Response System and Clinical Outcome in Hospitalized Children

Abstract

Heart rate and respiratory rate display circadian variation. Pediatric single-parameter rapid response system is activated when heart rate or respiratory rate deviate from age-specific criteria, though activation criteria do not differentiate between daytime and nighttime, and unnecessary activation has been reported due to nighttime bradycardia. We evaluated the relationship between rapid response system activation and the patient’s clinical outcome by separately applying the criteria to daytime and nighttime in patients < 18. The observation period was divided into daytime and nighttime (8:00–20:00, and 20:00 to 8:00), according to which measured heart rate and respiratory rate were divided and rapid response system activation criteria were applied. We classified lower nighttime than daytime values into the ‘decreased group’, and the higher ones into the ‘increased group’, to analyze their effect on cardiopulmonary resuscitation occurrence or intensive care unit transfer. Nighttime heart rate and respiratory rate were lower than the daytime ones in both groups (both p values < 0.001), with no significant association with cardiopulmonary resuscitation occurrence or intensive care unit transfer in either group. Heart rate and respiratory rate tend to be lower at nighttime; however, their effect on the patient’s clinical outcome is not significant.