Abstract
The trial assessed the accuracy of anaesthesia clinicians in estimating an anaesthetised patient’s systolic blood pressure (SBP) by feeling the radial pulse. To credit their accuracy to luck, skill or circumstance, the volunteer medical participants were sequentially randomized to one of four groups: one group given no help (control), the second allowed to feel the pulse, the third given pre- and peri-operative clinical information, the fourth given both. We set out to collect 60 estimates for each group (240 estimates). The accuracy of their estimations was assessed to clinical and statistical significance. Specific objectives were to determine whether palpation statistically improved estimation of SBP and whether it could be clinically useful. Irrespective of the level of training or self-confidence, the doctors in the study performed better statistically against controls and to within pre-determined clinical relevance ranges when they were allowed to palpate the radial pulse. The degree of accuracy was enhanced by giving pre- and peri-operative information to the extent that the participant clinicians were able to estimate the systolic blood pressure to within 30mmHg accuracy 96.7% of the time.
Highlights
Our results showed that a well-informed anaesthetic registrar or even consultant can accurately estimate his/her patient’s blood pressure by palpation of the radial pulse Clinical assessment of the patient’s blood pressure by palpation is historically part of the nurse’s and doctor’s skill set
The histograms illustrate the distribution of the data around the “0” error (Estimated systolic blood pressure (SBP)-True SBP = 0)
The palpation groups appear more clustered around the True SBP than the groups without palpation
Summary
Our results showed that a well-informed anaesthetic registrar or even consultant can accurately (within 15mmHg 80% of the time, within 20mmHg 86.67% of the time) estimate his/her patient’s blood pressure by palpation of the radial pulse Clinical assessment of the patient’s blood pressure by palpation is historically part of the nurse’s and doctor’s skill set. It was expected that the patient’s SBP could be estimated to within 10 or 20mmHg most of the time and estimations more than 20mmHg wide of the mark were unacceptable [1,2]. Some clinicians still believe they can reliably estimate the patient’s arterial blood pressure by palpation. We could find no previous studies on estimation of the anaesthetised patient’s blood pressure in this way. The few studies reaching publication support the accuracy of “the palpatory method” [3]. Correlation with sphygmomanometry and age-related patient physiology led authors to suggest adding 5mmHg to the palpatory estimate in patients under 25, and adding 10mmHg to the palpatory estimate in patients over 66
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