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Oscillometric and auscultatory blood pressure measurement methods in children: a systematic review and meta-analysis
Stephanie L Duncombe1, Christine Voss, Kevin C Harris
1Division of Cardiology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
Insights
Mercury-free blood pressure (BP) devices are needed for children. Oscillometric devices may be a suitable alternative for initial BP screening, though they showed slightly higher systolic BP readings compared to mercury devices.
Area of Science:
- Pediatric Medicine
- Cardiovascular Health
- Medical Device Technology
Background:
- Mercury sphygmomanometers are being phased out of clinical use.
- Accurate blood pressure (BP) measurement in children requires reliable mercury-free alternatives.
- Oscillometric and aneroid devices are emerging as potential replacements for mercury-based BP assessment.
Purpose of the Study:
- To systematically review and meta-analyze the accuracy of oscillometric and aneroid BP devices.
- To compare the accuracy of these devices against mercury sphygmomanometers in pediatric populations.
- To evaluate the suitability of non-mercury devices for measuring children's blood pressure.
Main Methods:
- Systematic search of four electronic databases (MEDLINE, Embase, CINAHL, Web of Science) and journals.
- Screening of 1415 articles, with 92 full-text articles undergoing independent review by two authors.
- Inclusion of 29 articles (38 studies) involving 26,879 children for meta-analysis.
Main Results:
- Oscillometric devices showed higher systolic BP (SBP) measurements than mercury devices (pooled estimate 2.53 mmHg).
- Validated oscillometric devices had smaller SBP differences (pooled estimate 1.76 mmHg).
- No significant difference was found for diastolic BP (DBP); aneroid devices showed comparable results to mercury devices.
Conclusions:
- Oscillometric devices show potential as a mercury-free alternative for initial BP screening in children.
- Further validation and standardization may be needed to optimize accuracy.
- Aneroid devices appear comparable to mercury devices for BP measurement in pediatric settings.
Background:
The phase-out of mercury from clinical settings calls for valid alternatives to assess blood pressure (BP) in children. Aneroid devices provide a mercury-free alternative to BP measurements by auscultation, whereas oscillometric (automated) devices are increasingly becoming the norm in clinical practice due to their ease of use. The aim of this systematic review and meta-analysis was to investigate the accuracy of oscillometric and aneroid BP devices compared with the mercury sphygmomanometer for the measurement of BP in children.
Methods:
We systematically searched four electronic databases (MEDLINE, Embase, CINAHL, and Web of Science) and relevant journals for eligible articles published before 30 July 2015. We screened 1415 articles, and two authors independently reviewed 92 full-text articles.
Results:
We included 29 articles (38 studies) with 26 879 children. Random-effects model meta-analyses revealed that oscillometric devices yield higher measurements of SBP than auscultation with a mercury sphygmomanometer (pooled effect estimate 2.53 mmHg; 95% CI 0.57-4.50; P < 0.05); the pooled effect estimate for SBP was smaller in studies that 'passed' validation protocols (1.76 mmHg; 95% CI 0.61-2.81; n = 12). There was no significant difference for DBP (pooled effect estimate 1.55 mmHg; 95% CI -0.20 to 3.31). There was heterogeneity between studies, explained in part by differences in manufacturer, study setting and observer training. Only three studies compared BP using aneroid and mercury devices and found comparable results.
Conclusion:
Oscillometric devices may serve as a suitable alternative to auscultation for initial BP screening in the pediatric population.
