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Terminal digit bias in a specialty hypertension faculty practice
S Thavarajah1, W B White, G A Mansoor
1Section of Hypertension and Clinical Pharmacology, University of Connecticut Health Center, Farmington, CT 06030, USA.
Journal of Human Hypertension
|January 6, 2004
Summary
Blood pressure (BP) readings show observer bias, with terminal digit preference noted in hypertension clinics. While lower than general clinics, this bias necessitates ongoing monitoring and training to ensure accurate BP measurement.
Area of Science:
- Cardiology
- Clinical Measurement
- Hypertension Management
Background:
- Traditional blood pressure (BP) measurement methods are prone to observer errors like terminal digit preference.
- Previous studies reported high percentages (60-90%) of zero as the terminal digit in BP readings from general clinics.
Purpose of the Study:
- To investigate terminal digit preference in BP measurements within a hypertension specialty practice.
- To identify clinical factors associated with zero preference in this specialized setting.
Main Methods:
- Retrospective chart review of patients at a hypertension clinic in September 2001.
- Data extraction included patient demographics, treatment status, and systolic/diastolic BP readings by nursing staff and physicians.
Main Results:
- Terminal digit preference was observed in BP readings from both nursing staff and physicians.
- Zero was the terminal digit for 40% of systolic BP readings by nurses and 31% by physicians.
- Diastolic BP readings showed 23% terminal zero by nurses and 36% by physicians, with nurses also favoring terminal digit 2 (43%).
- Physician diastolic BP readings with a terminal zero digit were associated with higher patient age (67 vs. 59 years) and lower BMI (28 vs. 32 kg/m²).
Conclusions:
- Evidence of terminal digit preference exists in BP measurements within a specialist hypertension clinic, though less frequent than in general settings.
- Lower observed bias may reflect enhanced training in BP measurement techniques.
- Regular monitoring and feedback are crucial to minimize measurement bias, even in specialized hypertension units.