Performance of User-Friendly Screening Tools for Elevated Blood Pressure in Children

CONTEXT: Hypertension is frequently undiagnosed in children. Several methods have been abstract developed to simplify screening for elevated blood pressure (BP) in children. OBJECTIVE: to assess the performance of different screening tools in identifying elevated BP in the pediatric population. DATA SOURCES: Data sources such as PubMed, Embase, Web of Science, Cochrane, and Scopus were searched up to March 2016. STUDY SELECTION: Studies providing measures of diagnostic performance of screening tools and that used age-, sex-, and height-specific BP percentile as the reference standard were included. DATA EXTRACTION: Data regarding the population, screening tools used to define elevated BP, and diagnostic criteria of BP were extracted. Available data on true-positive, false-positive, true-negative, and false-negative results were also extracted to construct a 2 x 2 contingency table. RESULTS: A total of 16 eligible studies that evaluated 366 321 children aged 3 to 18 years were included in the meta-analysis. Nine screening tools were included in this study, in which the BP-to-height ratio, the modified BP-to-height ratio, and tables based on age categories had the highest sensitivities (97-98%) but moderate specificities (71-89%). LIMITATIONS: Limitations included that BP measurements in most studies were based on 1 visit only and there was heterogeneity between the studies. CONCLUSIONS: Several user-friendly screening tools could improve the screening of elevated BP in the pediatric population.