Who (or what) is ViCTOR ?

You might be familiar with the expression “kids are just small adults” – reasonable in a few respects, but with regard to vital signs, you would already know they’re very different.

The service I work with is a few days away from introducing a new clinical approach for paediatric assessment, and this revision affirms that categorising the little tykes into just a couple of different categories is not the way forward.  If you think about it for a moment, it’s not really reasonable to expect that a 1 year old should have the same resting heart rate as an 8 year old !


Apologies to fans of ‘How I Met Your Mother’

The Victorian Children’s Tool for Observation and Response was developed through a collaboration of the The Royal Children’s Hospital and Monash Children’s Hospital to bring consistency to charting and alerting of paediatric vital signs.

Based on evidence established by observing more than 14,000 paediatric admissions, ViCTOR specifies age-specific vital sign limits for 5 different categories of paediatric patients – Small and Large Infants, and Small, Medium and Large children.

While the addition of more categories might initially seem daunting, these map directly to well-understood (and easy to remember) stages of development; Infants who are “Head Rollers” or “Head Holders”, Pre-School, Primary School and Secondary School children.

What I think is most encouraging though, is that our revised clinical approach won’t require practitioners to commit these new vital-sign ranges to memory – we are taking this opportunity to introduce decision-support tools (checklists and other references) into our regular practice.

This is a load off our minds, as well as providing a tremendous advantage in safety.

Here is a neat set of ViCTOR introduction videos with some great tips for getting a reliable vital signs in specific age ranges;


Or for more general information about how ViCTOR is used in hospitals, take a look here;

Scanning paeds

I’ve attended to more than one paediatric fall where parents or guardians have an expectation that their charge will be taken “for a scan” upon arrival at hospital (as seen on TV*).

The same parents or guardians are subsequently reassured if you are able to explain that this might not happen, unless there is a very very good reason to do so, given that emergency physicians try to avoid exposing kids to radiation unnecessarily.

But how much radiation are we talking, and what are the risks ?

Here’s a great post from Robert Cloutier at Academic Life in Emergency Medicine (ALiEM) which steps you through the radiation numbers and projected risks;


I think it’s good to know that a single CT can the the equivalent of hundreds of plain film X-ray images.

For some more detail on dosing in the adult population, you’ll find a handy summary table here;


Scanning paeds

*Television has a lot to answer for..