Oscillometric Measurement Research Articles

Intubation in the delivery room: Experience with nasal midazolam

BackgroundNeonates are often intubated in the delivery room (DR) without anesthesia because vascular access is impossible. AimsTo assess neonatal comfort and adverse events after use of nasal midazolam (nMDZ) for intubation in the DR. Study designProspective data collection over 6months on the intubation of neonates with respiratory distress requiring tracheal instillation of surfactant. SubjectsTwenty-seven neonates with median (Q25–75) gestational age and birthweight of, respectively, 29 (27–33)weeks and 1270 (817–1942)g received a 0.1mg/kg dose of nMDZ, and intubation was performed at the onset of tonus resolution or apnea. Outcome measuresComfort was assessed with a scale of hetero-pain assessment and electrical skin conductance monitoring. Continuous pulse oximetry was recorded in the first postnatal hour, with oscillometric blood pressure measurement every 10min. ResultsSeventy percent of the patients required a single dose, with intubation performed 4.8 (3–9)min after administration. Combined electro-clinical assessment found adequate comfort during the procedure in 68% of neonates. Mean blood pressure decreased from 39 (34–44)mmHg before to 31 (25–33)mmHg 1h following nMDZ (p=0.011). ConclusionnMDZ provided rapid and effective sedation to intubate neonates in the DR but potentially exposed them to hypotension, thus requiring close hemodynamic monitoring.

Detection of Hypotension During Cesarean Section With Continuous Noninvasive Arterial Pressure Device or Intermittent Oscillometric Arterial Pressure Measurement

Detection of Hypotension During Cesarean Section With Continuous Noninvasive Arterial Pressure Device or Intermittent Oscillometric Arterial Pressure Measurement

Improving Detection of Hypertension in Girls with Turner Syndrome Using Ambulatory Blood Pressure Monitoring

Background/Aims: Turner syndrome (TS) is associated with increased mortality due to cardiovascular disease and a dramatically higher rate of aortic dissection. The recognition and treatment of hypertension in this population is critical. We sought to assess the ability to detect blood pressure (BP) abnormalities comparing ambulatory blood pressure monitoring (ABPM) with conventional BP measurement methods. We hypothesized that ABPM would improve detection of hypertension and alter management strategies. Methods: Twenty-three girls with TS underwent BP measurements using an automated oscillometric method and a manual mercury sphygmomanometer. Twenty-four-hour ABPM was performed (Spacelabs 90217, Issaquah, Wash., USA). BP values were compared to normative data based on height and sex for ABPM, and for age, height and sex for automated oscillometric and manual measurements. Results: Five (22%) subjects were found to have ambulatory hypertension (3 of these with severe hypertension). Three subjects had prehypertension using ABPM measurements. Only 1 of the 5 patients with ambulatory hypertension was categorized as hypertensive using manual BP measurements. Twelve subjects (52%) had nocturnal hypertension. ABPM data led to a change in medical management of hypertensive patients with initiation of antihypertensive therapy. Conclusions: ABPM is advantageous in TS, as it improves detection of hypertension, identifies those with non-dipping BP patterns, and changes medical management of patients.

Comparison between oscillometric and intra-arterial blood pressure measurements in ill preterm and full-term neonates

Conflicting data exist regarding the accuracy of the oscillometric method of blood pressure (BP) measurement in neonates. There is limited data regarding intra-arterial BP trends in neonates. We aimed to determine the accuracy of oscillometric BP measurements and to evaluate the BP distributions in ill neonates. A total of 1492 simultaneously obtained oscillometric and intra-arterial (umbilical arterial [UAC] or radial arterial) BP measurements were used for comparisons and 125,580 intra-arterial BP readings were used to the evaluate BP distribution. There was a statistically significant difference (P < .0001) between the oscillometric and radial mean arterial BP (MAP) 4.8 ± 9.8 mm Hg, systolic BP 8.3 ± 11.6 mm Hg, diastolic BP 4.3 ± 9.3 mm Hg and between the oscillometric and UAC systolic BP 5.2 ± 11.9 mm Hg and diastolic BP −0.8 ± 10.4 mm Hg. The MAP increased with increases in weight (35.3 ± 4.92 mm Hg/kg), post-menstrual age (−0.29 ± 1.41 mm Hg/week) and advanced gestational age at birth (13.12 ± 0.90 mm Hg/week). Oscillometric BP measurements are not equivalent to the intra-arterial (UAC or radial arterial) BP in ill neonates. The BP increases with increase in weight, gestational age at birth, and post-menstrual age in ill neonates.

Response to Does Atrial Fibrillation Affect the Automated Oscillometric Blood Pressure Measurement?

We thank Stergiou and coworkers for their interest in our study.1 The authors criticize that we did not use a validation protocol. The present study examines the impact of one single parameter (atrial fibrillation, AF) on the accuracy of oscillometry. It is not a validation study. The performance of a device in a validation procedure is determined by a broad variety of parameters. Bland–Altman analysis—as used in our study—is the statistical gold standard to assess the accuracy of a measurement technique and allows to analyze the impact of a single parameter like AF by statistical comparison of the resulting biases.2 Furthermore, the …

Does Atrial Fibrillation Affect the Automated Oscillometric Blood Pressure Measurement?

We read with interest the article by Pagonas et al1 on the accuracy of oscillometric blood pressure (BP) monitors in atrial fibrillation (AF). An important point raised by the authors is that AF impedes both oscillometric and auscultatory BP measurement1 and disagreement between them does not necessarily mean that the latter is the correct one. Thus, intra-arterial measurements were used as reference.1 The main issue with this analysis is that established validation criteria have not been applied. We re-evaluated these results using the Association for Advancement of Medical Instrumentation (AAMI) validation criteria of accuracy …

Fluid challenge: tracking changes in cardiac output with blood pressure monitoring (invasive or non-invasive)

To assess whether invasive and non-invasive blood pressure (BP) monitoring allows the identification of patients who have responded to a fluid challenge, i.e., who have increased their cardiac output (CO). Patients with signs of circulatory failure were prospectively included. Before and after a fluid challenge, CO and the mean of four intra-arterial and oscillometric brachial cuff BP measurements were collected. Fluid responsiveness was defined by an increase in CO ≥10 or ≥15% in case of regular rhythm or arrhythmia, respectively. In 130 patients, the correlation between a fluid-induced increase in pulse pressure (Δ500mlPP) and fluid-induced increase in CO was weak and was similar for invasive and non-invasive measurements of BP: r² = 0.31 and r² = 0.29, respectively (both p < 0.001). For the identification of responders, invasive Δ500mlPP was associated with an area under the receiver-operating curve (AUC) of 0.82 (0.74-0.88), similar (p = 0.80) to that of non-invasive Δ500mlPP [AUC of 0.81 (0.73-0.87)]. Outside large gray zones of inconclusive values (5-23% for invasive Δ500mlPP and 4-35% for non-invasive Δ500mlPP, involving 35 and 48% of patients, respectively), the detection of responsiveness or unresponsiveness to fluid was reliable. Cardiac arrhythmia did not impair the performance of invasive or non-invasive Δ500mlPP. Other BP-derived indices did not outperform Δ500mlPP. As evidenced by large gray zones, BP-derived indices poorly reflected fluid responsiveness. However, in our deeply sedated population, a high increase in invasive pulse pressure (>23%) or even in non-invasive pulse pressure (>35%) reliably detected a response to fluid. In the absence of a marked increase in pulse pressure (<4-5%), a response to fluid was unlikely.

Impact of Atrial Fibrillation on the Accuracy of Oscillometric Blood Pressure Monitoring

The introduction of automated oscillometric blood pressure monitors was the basis for today's widespread use of blood pressure self-measurement. However, in atrial fibrillation, there is a controversial debate on the use of oscillometry because there is a high variability of heart rate and stroke volume. To date, the accuracy of oscillometric blood pressure monitoring in atrial fibrillation has only been investigated using auscultatory sphygmomanometry as reference method, which may be biased by arrhythmia as well. We performed a cross-sectional study in 102 patients (52 sinus rhythm, 50 atrial fibrillation) assessing the accuracy of an automated and validated oscillometric upper arm (M5 Professional, Omron) and wrist device (R5 Professional, Omron) to invasively assessed arterial pressure. Blood pressure values were calculated as the mean of 3 consecutive measurements. Systolic and diastolic blood pressure did not significantly differ in patients with sinus rhythm and atrial fibrillation, independent of the method of measurement (P>0.05 each). The within-subject variability of the oscillometric measurements was higher in patients with atrial fibrillation compared with sinus rhythm (P<0.01 each). The biases of systolic and diastolic blood pressure, however, did not significantly differ in presence or absence of atrial fibrillation in Bland-Altmann analysis (P>0.05 each). In conclusion, atrial fibrillation did not significantly affect the accuracy of oscillometric measurements, if 3 repeated measurements were performed.

Oscillometric measurement of brachial artery cross-sectional area and its relationship with cardiovascular risk factors and arterial stiffness in a middle-aged male population

An enlarged arterial diameter is associated with an increased risk for cardiovascular disease. This study examined the relationship of noninvasively measured brachial artery cross-sectional area with cardiovascular risk factors and arterial stiffness in a middle-aged male population. Absolute volumetric changes of the brachial artery were measured with a newly developed oscillometric method during a general health examination in 387 men (mean age: 38±9 years) without known cardiovascular disease. Based on the measurement, the estimated area (eA) of the brachial artery at end-diastole was obtained. Brachial artery volume elastic modulus (VE) and brachial-ankle pulse wave velocity (baPWV) were simultaneously measured as indices of arterial stiffness by the same device. The relationships of eA with cardiovascular risk factors, including age, obesity, hypertension, dyslipidemia, impaired fasting glucose/diabetes mellitus (IFG/DM), hyperuricemia, smoking and their associated continuous variables, as well as VE and baPWV, were examined. Overall, the mean eA was 12.9 ± 2.9 mm². The eA was significantly higher in subjects with obesity, hypertension or IFG/DM than in those without each of these risk factors. In a multiple linear regression analysis, body mass index (β=0.31, P<0.001), age (β=0.25, P<0.001), systolic blood pressure (β=0.16, P=0.004) and pulse rate (β=-0.13, P=0.005) were independent determinants of eA. In contrast, neither VE nor baPWV were selected as independent determinants of eA. In conclusion, enlarged brachial artery cross-sectional area was significantly associated with cardiovascular risk factors such as age, body mass index and systolic blood pressure, but it was not associated with increased arterial stiffness.

Comparison of Automated Oscillometric Measurement of Ankle Brachial Index with Standard Doppler Measurement as a Screening Tool for Peripheral Artery Disease

Objective —The use of continuous-wave Doppler ultrasound to determine ankle brachial index (ABI) is the gold standard for diagnosing asymptomatic peripheral artery disease. This method is labor intensive, requires training, and has considerable interobserver variability. Automated oscillometric measurement (AOM) of blood pressure is fast, simple, and generally available in clinics, but there are few studies of its usefulness for determination of the ABI. We compared these two methods to determine the usefulness of AOM as a screening tool. We also assessed the agreement between two different AOM devices. Methods —Seventy-four patients, including 33 diabetics, who presented to our vascular clinic to have their ABI measured were enrolled. A vascular nurse certified in ABI measurements (J.B.) performed blood pressure measurements in all four extremities by using the traditional Doppler method and two different automated oscillometric devices. The order of the three measurements was randomized. To avoid the effect of interrelated measures within each subject, we analyzed left and right legs separately (74 for each group). Measurements were grouped as abnormal (ABI = 0.90), normal (ABI 0.91–1.30), or elevated (ABI &gt; 1.30). Agreement between Doppler measurements and oscillometric measurements was investigated by use of Pearson's χ2 analysis. In addition, correlation coefficients, including Spearman and Gamma statistic, were computed, as was the Kappa statistic, a measure of interrater agreement. Results —The correlation coefficients for comparison of Doppler with the two AOM devices were 0.70 and 0.73 ( p &lt; 0.01). For the diabetics, correlation coefficients were 0.64 and 0.70 ( p &lt; 0.01). The intermachine correlation ranged from 0.65 to 0.69 ( p &lt; 0.01). As a screening tool oscillometric measurement had a sensitivity of 44%, specificity of 96%, positive predictive value of 87%, negative predictive value of 68%, and am accuracy of 73%. Kappa statistic was 0.41. Conclusions —Oscillometric measurement of ABI had good correlation with Doppler ultrasound measurements, and there was little difference between the two different machines tested. AOM has value as a rapid, initial screening examination in primary care clinics. When positive, the examination is a reliable indicator of atherosclerosis to identify patients who need intense risk factor modification. When negative, it is only moderately predictive of the absence of disease. Patients suspected of high risk for atherosclerosis who have negative examinations require further testing.

Detection of Hypotension During Caesarean Section With Continuous Non-Invasive Arterial Pressure Device or Intermittent Oscillometric Arterial Pressure Measurement

Ilies, C.*; Kiskalt, H.†; Siedenhans, D.†; Meybohm, P.*; Steinfath, M.*; Bein, B.*; Hanss, R.* Author Information

Noninvasive Transcutaneous Doppler Ultrasound–Derived Hemodynamic Reference Ranges in Chinese Adolescents

The ultrasonic cardiac output monitor is a noninvasive, quantitative method for measuring and monitoring cardiovascular hemodynamic parameters in patients. The aims of this study were first to establish reference ranges for cardiovascular indices measured by the ultrasonic cardiac output monitor in Chinese children aged 12-18 yr, second to assess the interobserver reliability of the method, and third to compare these ranges with a Caucasian group from Australia. This was a population-based cross-sectional cohort study of Chinese adolescents 12-18 years old, performed in secondary schools in Hong Kong. Ultrasonic cardiac output monitor scans were performed on each subject to measure stroke volume, cardiac output, and systemic vascular resistance together with standard oscillometric measurement of blood pressure and heart rate. Ultrasonic cardiac output monitor parameters were also standardized by deriving body surface area referenced indices. Normal ranges were defined as lying within two standard deviations on either side of the mean. To assess interobserver variability, a second, blinded operator repeated 17% of scans. A total of 590 Chinese adolescents (49% boys) were scanned. Normal ranges for cardiac output, cardiac index, stroke volume, stroke volume index, stroke volume resistance, and systemic vascular resistance index are presented. Males had a significantly higher mean stroke volume, cardiac output, and systemic vascular resistance index compared with females (p < 0.05), but no significant differences were found for the indexed values. When compared with a group of 31 Australian Caucasian adolescents (71% boys), Chinese adolescents have a significantly lower cardiac output and stroke volume (p <0.05), but these differences disappeared when adjusted for body surface area (i.e., stroke volume index, cardiac index, and systemic vascular resistance index). Interobserver variability of ultrasonic cardiac output monitor-derived stroke volume showed a coefficient of variation of 10.2%, a correlation coefficient of 0.90 (95% confidence interval 0.85-0.93), while Bland-Altman analysis showed a mean bias of 1.5% (95% limits of agreement were -19.9% to 23.0%). This study presents normal values for cardiovascular indices in Chinese adolescents using the ultrasonic cardiac output monitor. When referenced to body surface area, the differences between Caucasians and Chinese were insignificant.

Oscillometric estimation of aortic pulse wave velocity

Recently, a novel method to estimate aortic pulse wave velocity (aPWV) noninvasively from an oscillometric single brachial cuff waveform reading has been introduced. We investigated whether this new approach provides acceptable estimates of aPWV compared with intra-aortic catheter measurements. Estimated values of aPWV obtained from brachial cuff readings were compared with those obtained using an intra-aortic catheter in 120 patients (mean age 61.8±10.8 years) suspected for coronary artery disease undergoing cardiac catheterization. Differences between aPWV values obtained from the test device and those obtained from catheter measurements were estimated using Bland-Altman analysis. The mean difference±SD between brachial cuff-derived values and intra-aortic values was 0.43±1.24 m/s. Comparison of aPWV measured by the two methods showed a significant linear correlation (Pearson's R=0.81, P<0.0001). The mean difference for repeated oscillometric measurements of aPWV was 0.05 m/s, with 95% confidence interval limits from -0.47 to 0.57 m/s. aPWV can be obtained using an oscillometric device with brachial cuffs with acceptable accuracy compared with intra-aortic readings.

Assessment of the biological effects of welding fumes emitted from metal inert gas welding processes of aluminium and zinc-plated materials in humans

The aim of this study was to investigate biological effects and potential health risks due to two different metal-inert-gas (MIG) welding fumes (MIG welding of aluminium and MIG soldering of zinc coated steel) in healthy humans. In a threefold cross-over design study 12 male subjects were exposed to three different exposure scenarios. Exposures were performed under controlled conditions in the Aachener Workplace Simulation Laboratory (AWSL). On three different days the subjects were either exposed to filtered ambient air, to welding fumes from MIG welding of aluminium, or to fumes from MIG soldering of zinc coated materials. Exposure was performed for 6 h and the average fume concentration was 2.5 mg m(-3). Before, directly after, 1 day after, and 7 days after exposure spirometric and impulse oscillometric measurements were performed, exhaled breath condensate (EBC) was collected and blood samples were taken and analyzed for inflammatory markers. During MIG welding of aluminium high ozone concentrations (up to 250 μg m(-3)) were observed, whereas ozone was negligible for MIG soldering. For MIG soldering, concentrations of high-sensitivity CRP (hsCRP) and factor VIII were significantly increased but remained mostly within the normal range. The concentration of neutrophils increased in tendency. For MIG welding of aluminium, the lung function showed significant decreases in Peak Expiratory Flow (PEF) and Mean Expiratory Flow at 75% vital capacity (MEF 75) 7 days after exposure. The concentration of ristocetin cofactor was increased. The observed increase of hsCRP during MIG-soldering can be understood as an indicator for asymptomatic systemic inflammation probably due to zinc (zinc concentration 1.5 mg m(-3)). The change in lung function observed after MIG welding of aluminium may be attributed to ozone inhalation, although the late response (7 days after exposure) is surprising.

Evaluation of the oscillometric technique for intermittent non-invasive arterial blood pressure measurement in the anaesthetized pig

This study was designed to evaluate the oscillometric technique for intermittent non-invasive measurement of arterial pressure (AP) in the anaesthetized pig. In six pigs under sevoflurane anaesthesia, intermittent (every 2 minutes) oscillometric measurements of AP made at a forelimb (FL), a hindlimb (HL) and the tail base were compared with simultaneous direct AP measurements made at the aortic arch (AA) over a wide pressure range (30-140 mmHg of mean AP). All oscillometric measurements strongly correlated (Pearson correlation coefficient >0.837, P < 0.001) with direct AP measurements, with those made at the FL exhibiting the highest correlation. On the basis of consistency of difference between oscillometric and AA pressure readings at graded pressure levels, measurements made at the tail base provided reliable prediction of systolic AP, at the FL of diastolic AP and at both the tail base and the FL of mean AP. In conclusion, oscillometric measurements at the FL and the tail base offer reliable prediction of AP in the anaesthetized pig.

Putting Evidence Into Nursing Practice: Four Traditional Practices Not Supported by the Evidence

Evidence-based nursing practice is essential to the delivery of high-quality care that optimizes patients' outcomes. Studies continue to show improved outcomes when best evidence is used in the delivery of patient care. Despite awareness of the importance of practicing by using best evidence, achieving and sustaining evidence-based practice within practice environments can be challenging, and research suggests that integration of evidence-based practice into daily clinical practice remains inconsistent. This article addresses 4 practice issues that, first, are within the realm of nursing and if changed might improve care of patients and, second, are areas in which the tradition and the evidence do not agree and practice continues to follow tradition. The topics addressed are (1) noninvasive measurement of blood pressure in children, (2) oxygen administration for patients with chronic obstructive pulmonary disease, (3) intravenous catheter size and blood administration, and (4) infection control practices to prevent infections. The related beliefs, current evidence, and recommendations for practice related to each topic are described.

Metabolic syndrome and its effect on aortic stiffness in premenopausal women

Metabolic syndrome (MS) is a cluster of proatherogenic risk factors (RF) (abdominal obesity, atherogenic dyslipidemia, impaired fasting glucose or type 2 diabetes mellitus, higher blood pressure or antihypertensive therapy) that move patients into a higher risk for development of cardiovascular disease (CVD) and type 2 diabetes. The preclinical (subclinical) target organ diseases (SOD) are early signs of atherosclerosis. An increased aortic stiffness characterised by an increased pulse wave velocity in aorta (PWV Ao) is one of SOD.The aim of the present study was to assess the impact of metabolic syndrome (MS) on aortic wall stiffness and the risk profile in premenopausal women. The aortic stiffness was measured using Arteriograph-Tensiomed, based on oscillometric measurement and analysis of the shape of brachial pulse wave, giving the PWV Ao. The results of measurements characterise a global aortic stiffness. We examined 81 premenopausal women (without history of CVD). The MS (according to the 2009 "harmonizing" definition) was present in 31 women (mean age 41.5 y), in the control group, there were 50 women (39 y). The most frequent components of MS were abdominal obesity (93 % vs 42%), arterial hypertension (68 % vs 10 %) and dyslipidemia (29 % vs 8 %). The PWV Ao was significantly higher in women with MS (9.26 m/s) compared to the control group (7.44 m/s). The aortic stiffness in women with MS compared to controls was significantly higher despite a presumed general protective hormonal effect on cardiovascular system in women with child-bearing potential (Tab. 4, Ref. 25).

Comparison of the average of five readings with averages from fewer readings for automated oscillometric blood pressure measurement in an outpatient clinic.

Background and ObjectivesThe optimal number of consecutive measurements for obtaining an average blood pressure (BP) reading in clinical practice is yet undefined by research. This study aimed to compare readings obtained from an average of 5 with averages of 2, 3, and 4, sequential measurements.Subjects and MethodsUsing an automated oscillometric device (BpTRU), BP measurement was conducted on 410 consenting adults attending a general outpatients clinic. Comparison of an average of 5 readings with averages of 2, 3, and 4 readings involved evaluation of correlations, Bland-Altman analysis, comparison of means and distribution of readings, and determination of the proportion of differences between compared readings which were clinically non-significant.Results397 (96.8%) sets of complete BP readings were suitable for analysis. Clinically non-significant differences (≤5 mm Hg) were found between at least 79.3% (n=315) and 96.5% (n=383) of compared systolic and diastolic readings, respectively. Bland-Altman's analysis revealed that the 95% limits of agreement for the differences between compared readings were approximately 2-4, 3-7, and 4-11 mm Hg for 2, 3 and 4 readings' systolic comparisons while those for diastolic comparisons were 2-3, 3-5, and 4-7 mm Hg, respectively. Statistically non-significant differences were observed in all comparisons of the distributions of readings that were classified as <140 mm Hg or ≥140 mm Hg and <90 mm Hg or ≥90 mm Hg for systolic and diastolic readings, respectively. Strong positive correlations were found between 5 average readings and each of 2, 3, and 4 average readings, respectively.ConclusionAn average of 5 readings may be excessive for routine BP measurement using this device at outpatient clinics.

Comparison of high definition oscillometric and Doppler ultrasound devices with invasive blood pressure in anaesthetized dogs

ObjectiveTo use the American College of Veterinary Internal Medicine (ACVIM) validation criteria to evaluate the performance of high definition oscillometric (HDO) and Doppler blood pressure measurement techniques against invasive blood pressure measurements in anaesthetized dogs. Study designProspective clinical study. AnimalsTwenty client-owned dogs. Materials and MethodsInvasive blood pressure was measured using a catheter inserted into a pedal artery and an electronic transducer. The sites of cuff placement for the HDO measurements were the mid antebrachium or the proximal tail and, for the Doppler technique, the distal tibia. Agreement between invasive and non-invasive blood pressure measurements was estimated by the Bland–Altman method. ResultsOnly 10% and 34% of Doppler measurements were within 10 and 20 mmHg of invasive blood pressure values, respectively. The Doppler device failed to meet the ACVIM validation criteria for blood pressure measurement devices. The best agreement between HDO and invasive blood pressure measurement technique was observed for mean arterial blood pressure (MAP); 67% and 95% of readings were within 10 and 20 mmHg of invasive blood pressure values respectively. In addition, 52% and 87% of diastolic arterial blood pressure (DAP) measurements were within 10 and 20 mmHg of invasive readings. High definition oscillometric readings did not meet ACVIM recommended limits for SAP. Conclusion and clinical relevanceThe Doppler technique overestimated and the HDO device showed limited agreement with invasive blood pressure measurement in anaesthetized dogs. High definition oscillometry met most of the ACVIM requirements for MAP and DAP while the Doppler technique did not.

Comparison between oscillometric- and Doppler-ABI in elderly individuals

Peripheral arterial disease (PAD) generally remains under-recognized, mainly due to the specialized technical skills required to detect the low values of the ankle-brachial index (ABI). As a simpler and faster alternative to the standard method using continuous-wave Doppler ultrasound, we evaluated automated oscillometric ABI measurement by VP-2000 with an elderly cohort of 113 subjects (age range, 61 to 88 years). The standard deviation in ABIs measured by the Doppler method was statistically greater than that measured by the oscillometric method for each of the two legs (P < 0.001). Correlations in ABIs between the two methods were 0.46 for the left leg and 0.61 for the right leg; this result appears to have been caused by interobserver variation in the Doppler ABI measurements. While the trend showing greater differences between average oscillometric- and Doppler-ABIs was significant at the lower ABI ranges, there was little indication of differences in measurements having an average ABI > 1.1. The difference between the methods was suggestively larger in subjects who were smokers than in non-smokers (P = 0.09), but the difference was not affected by other potential atherosclerotic risk factors, including age at examination (P > 0.50). A larger difference at lower ABIs led to better PAD detection by the Doppler method compared to the oscillometric method (sensitivity = 50%, specificity = 100%), although the overall agreement was not small (Cohen’s Kappa = 0.65). Our findings indicate that oscillometric devices can provide more accurate estimation of the prevalence of PAD in elderly individuals than the conventional Doppler method.