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Comparability of oscillometric to simultaneous auscultatory blood pressure measurement in children
Jennifer S Ringrose1,2, Abdullah Alabbas3, Afrooz Jalali1
1Departments of Medicine.
Insights
Automated blood pressure (BP) measurement accuracy in children remains uncertain. This study found oscillometric BP devices differed significantly from manual auscultation, particularly in younger children, highlighting the need for improved accuracy in pediatric BP monitoring.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Research
- Medical Device Technology
Background:
- Automated blood pressure (BP) measurement in children lacks established accuracy standards.
- Oscillometric devices are widely used but their precision in pediatric populations requires further investigation.
Purpose of the Study:
- To compare the accuracy of two standard oscillometric BP measurement algorithms against simultaneous auscultatory measurements in children.
- To evaluate the performance of oscillometric BP derivation methods across different age groups within the pediatric population.
Main Methods:
- Twenty children aged 2-12 years underwent simultaneous oscillometric and auscultatory BP measurements.
- Two oscillometric BP algorithms (fixed-ratio and slope-based) were used to derive BP values from recorded waveforms.
- BP readings were compared to simultaneous auscultatory measurements, with the first reading discarded and the second used for analysis.
Main Results:
- Both fixed-ratio and slope-based oscillometric methods showed statistically significant differences in diastolic BP compared to auscultation.
- The fixed-ratio method showed a mean difference of 5.80±12.72/6.85±7.51 mmHg (systolic/diastolic) from auscultation.
- The slope-based method showed a mean difference of -1.80±13.59/10.15±8.07 mmHg (systolic/diastolic) from auscultation, with the largest discrepancies in younger children.
Conclusions:
- Oscillometric BP measurements derived using common algorithms can differ by over 5 mmHg from auscultatory BP in children aged 2-11 years.
- Significant differences, especially in diastolic BP, were observed across all age categories, with greater magnitude in younger children.
- Further research is needed to understand the functionality and enhance the accuracy of oscillometric BP devices for pediatric use.
Objective:
Uncertainty exists regarding the accuracy of automated blood pressure (BP) measurement in children. We recorded oscillometric waveforms in children, derived oscillometric BPs using two standard algorithms, and compared the results to simultaneous auscultation.
Patients And Methods:
Twenty children aged 2-12 years were recruited from a tertiary-care Pediatric Nephrology Clinic. Sex, height, weight, arm circumference, history of hypertension, and clinic BP were recorded. Two, simultaneously measured, oscillometric and auscultatory BP readings were obtained 30-60 s apart. The first reading was discarded and, the second, used for analyses. Fixed-ratio and slope-based algorithms were used for BP derivation.
Results:
Mean age was 7.95±2.82 years, 40% were female, mean arm circumference was 21.86±4.06 cm, and 50% had hypertension or a history of hypertension. Mean auscultatory BP for all participants (systolic±SD/diastolic±SD) was 93.40±11.80/50.50±9.04 mmHg, oscillometric fixed-ratio BP was 99.20±11.90/57.35±7.15 mmHg and oscillometric slope-based algorithm was 91.60±13.94/60.65±7.71 mmHg. Compared to auscultation, the fixed-ratio method differed by 5.80±12.72/6.85±7.51 mmHg (P=0.06 and <0.01) and the slope-based method differed by -1.80±13.59/10.15±8.07 mmHg (P=0.56 and <0.01). Differences from auscultation were statistically significant for diastolic BP with both fixed-ratio and slope-based methods for all age categories but of greatest magnitude in the youngest children.
Conclusion:
Oscillometric BP derived using two commonly used algorithms differed by more than 5 mmHg in either systolic BP or diastolic BP from simultaneous auscultatory BP in children aged 2-11. These findings emphasize the need for greater understanding of the functionality and accuracy of oscillometry in children.
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