Sources of error in measurement of children's blood pressure in a large epidemiologic study: Bogalusa Heart Study
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Accurate pediatric blood pressure measurement requires trained observers and multiple readings. Observer differences are the biggest preventable factor in blood pressure variability during surveys.
Area of Science:
- Pediatric Epidemiology
- Cardiovascular Health
- Biostatistics
Background:
- Accurate blood pressure measurement is critical for identifying early hypertensive disease in children.
- Variability in blood pressure readings can complicate accurate diagnosis and epidemiological assessment.
Purpose of the Study:
- To examine changes in children's blood pressure with multiple measurements.
- To assess differences between field observers in blood pressure measurements.
- To identify key contributors to blood pressure variability in a pediatric epidemiological survey.
Main Methods:
- Utilized a random effects analysis of variance model.
- Conducted multiple blood pressure measurements by trained field observers on a large pediatric cohort.
- Analyzed systolic and diastolic blood pressure readings for inter-observer and intra-subject variability.
Main Results:
- Observer differences constituted the largest preventable source of blood pressure variation.
- Systolic blood pressure showed a decrease of approximately 2.5 mmHg from the first to the third measurement station.
- Over 86% of systolic and 90% of diastolic readings between two observers on the same child were within a 15 mmHg range.
Conclusions:
- Emphasizes the critical need for rigorous training of field observers in pediatric blood pressure measurement.
- Recommends the use of replicate measurements by multiple observers to enhance accuracy in epidemiological surveys.
- Highlights strategies to minimize preventable blood pressure variability for reliable pediatric health assessments.
Abstract:
Accurate and reliable measurement of blood pressure is essential in the determination of early hypertensive disease. Multiple blood pressure measures were determined by well trained field observers on a large number of children representing a total pediatric community. Changes in children's blood pressure levels with multiple measurements, as well as differences between field observers, were examined. A random effects analysis of variance model was used to determine specific contributors to blood pressure variability in an epidemiologic survey of children. Observer differences were found to be the largest preventable contributor to blood pressure variation. In addition, systolic blood pressure levels decreased approx. 2.5 mmHg from the first to the third blood pressure station. More than 86% of systolic blood pressure readings and 90% of diastolic blood pressure readings by two different observers on the same child were within 15 mmHg. These data emphasize the importance of both adequate training of field observers and the use of replicate blood pressure measurements by multiple observers to determine blood pressure levels accurately in an epidemiologic survey.