In-Use Comparison of Blood Pressure Measurements from an Automated Blood Pressure Instrument with Those from a Mercury Sphygmomanometer

Abstract

In addition to its ease of use and degree of independence from the subjectivity inherent in measurements made with the mercury sphygmomanometer (HgS), automated blood pressure measurement instruments (ABPMI) obviate the use of mercury-containing instrumentation and the attendant environmental issues. Thus, they have been widely used in healthcare facilities worldwide. Most evaluations of ABPMI have focused on their compliance with established international protocols, and there has been a paucity of studies examining their performance in actual use in healthcare facilities. The purpose of this study was to evaluate the ABPMI used in our institution--a large, urban, tertiary-care teaching hospital in the northeastern United States--under routine conditions. This device, the Dinamap ProCare 400 Monitor, was compared to HgS (considered the "gold standard" for non-invasive blood pressure measurement) with respect to key analytical variables, i.e., precision of measurements and correlation within a large (n=300) sample of patients. Several sources of observer bias with HgS were detected. Precision varied among parameter (systolic blood pressure [SBP]; diastolic blood pressure [DBP]; and mean arterial pressure [MAP]) and level (normotensive, moderately hypertensive, and severely hypertensive). Correlation and regression suggested a strong association between the methods and Bland-Altman analysis indicated an acceptably small systematic error (bias) but greater random error than that demonstrated by previous evaluations with international test protocols. We recommend that healthcare facilities evaluate ABPMI under actual conditions and that formal protocols be established for these evaluations under routine conditions of patient care.

A systematic review of variability and reliability of manual and automated blood pressure readings

“…1998), but in the remainder of the studies, the specific clinical setting was not stated or more general terms such as outpatient clinics (De Greeff et al. 2007) or general wards Gupta et al. 2009) were used.…”

“…The order in which measurements were taken is not recorded by Carney et al. (1999) or Gupta et al. (2009).…”

“…In the second phase of one study (Campbell et al 2005), observations were made by clinical nurses, while measurements taken by nurses with or without specific training were compared by Roubsanthisuk et al (2007). Gupta et al (2009) studied readings made by medical residents. In one paper, it was not stated how the instruments were compared (Dieterle et al 1998).…”

Comparison of Water Manometry to 2 Commercial Electronic Pressure Monitors for Central Venous Pressure Measurement in Horses

“…2 Monitoring CVP by electronic pressure monitors could provide a less labor intensive method to obtain clinically relevant and continuous readings, and has been shown to remove human error in the measurement and monitoring of blood pressure in humans. 7 Electronic pressure monitors use piezoresistive technology to convert direct mechanical pressure from the circulation into a measurable electrical signal, 8 and may give more accurate and repeatable measurements, save time with more instantaneous readings and remove some interreader variation. 7 However, before implementation in horses, these devices, which are designed and validated for 50 kg humans, should be demonstrated to be comparable to the most commonly used technique, water manometry.…”

“…7 Electronic pressure monitors use piezoresistive technology to convert direct mechanical pressure from the circulation into a measurable electrical signal, 8 and may give more accurate and repeatable measurements, save time with more instantaneous readings and remove some interreader variation. 7 However, before implementation in horses, these devices, which are designed and validated for 50 kg humans, should be demonstrated to be comparable to the most commonly used technique, water manometry. The aim of this study was to evaluate the agreement of CVP values obtained with water manometry and 2 commercially available bedside monitoring devices, the Datascope Passport LT and Medtronic Lifepak 12.…”