Quantitative Assessment of Blood Pressure Measurement Accuracy and Variability from Visual Auscultation Method by Observers without Receiving Medical Training.

Wenai Chen,Fei Chen,Yong Feng,Dingchang Zheng,Aiqing Chen

doi:10.1155/2017/3537079

Abstract

This study aimed to quantify blood pressure (BP) measurement accuracy and variability with different techniques. Thirty video clips of BP recordings from the BHS training database were converted to Korotkoff sound waveforms. Ten observers without receiving medical training were asked to determine BPs using (a) traditional manual auscultatory method and (b) visual auscultation method by visualizing the Korotkoff sound waveform, which was repeated three times on different days. The measurement error was calculated against the reference answers, and the measurement variability was calculated from the SD of the three repeats. Statistical analysis showed that, in comparison with the auscultatory method, visual method significantly reduced overall variability from 2.2 to 1.1 mmHg for SBP and from 1.9 to 0.9 mmHg for DBP (both p < 0.001). It also showed that BP measurement errors were significant for both techniques (all p < 0.01, except DBP from the traditional method). Although significant, the overall mean errors were small (−1.5 and −1.2 mmHg for SBP and −0.7 and 2.6 mmHg for DBP, resp., from the traditional auscultatory and visual auscultation methods). In conclusion, the visual auscultation method had the ability to achieve an acceptable degree of BP measurement accuracy, with smaller variability in comparison with the traditional auscultatory method.

Highlights

Hypertension is the third leading cause of death worldwide [1]
It is shown that the visual auscultation method significantly reduced SD of repeats (p < 0.001 for both systolic blood pressure (SBP) and diastolic blood pressure (DBP)), with an overall decrease across the 10 observers from 2.2 to 1.1 mmHg for SBP and from 1.9 to 0.9 mmHg for DBP
There were significant systematic measurement errors of no more than 2 mmHg for both SBP and DBP, since all the measurements were performed by observers without receiving professional training who was only provided with very simple instructions on Blood pressure (BP) determination, the outcome of measurement accuracy should be considered to be satisfactory

Summary

Introduction

Hypertension is the third leading cause of death worldwide [1]. Cardiovascular disease causes 17 million deaths per annum globally with complications arising from hypertension accounting for 9.4 million [2]. Manual auscultatory BP measurement has been in use for over 100 years and has changed little over this time, which has been regarded as the most accurate and the gold standard noninvasive clinical BP measurement technique. It is used as a reference technique for evaluating automated BP devices [6]. Regarding the measurement principle of the manual auscultatory technique, systolic blood pressure (SBP) is defined when the Korotkoff sound appears for the first time during cuff pressure deflation, and diastolic blood pressure (DBP) is noted when the Korotkoff sound disappears

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Results

Conclusion