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Comparative Study
. 2012 Mar;160(3):434-440.e1.
doi: 10.1016/j.jpeds.2011.08.071. Epub 2011 Nov 1.

Reliability of resting blood pressure measurement and classification using an oscillometric device in children with chronic kidney disease

Joseph T Flynn  1 , Christopher B Pierce, Edgar R Miller 3rd, Jeanne Charleston, Joshua A Samuels, Juan Kupferman, Susan L Furth, Bradley A Warady; Chronic Kidney Disease in Children Study Group
Collaborators, Affiliations
Comparative Study

Reliability of resting blood pressure measurement and classification using an oscillometric device in children with chronic kidney disease

Joseph T Flynn et al. J Pediatr. 2012 Mar.

Abstract

Objective: To compare the reliability of blood pressure (BP) readings obtained with an oscillometric device with those obtained by auscultation and assess for differences in BP status classification based on the 2 techniques.

Study design: Resting BP was measured by auscultation and with an oscillometric device at the same encounter in 235 subjects enrolled in the Chronic Kidney Disease in Children study. Resting auscultatory BP values were averaged and compared with averaged oscillometric readings. BP agreement by the 2 methods was assessed using Bland-Altman plots, and BP status classification agreement was assessed by calculation of kappa statistics.

Results: Oscillometric BP readings were higher than auscultatory readings, with a median paired difference of 9 mm Hg for systolic BP (SBP) and 6 mm Hg for diastolic BP (DBP). Correlation for mean SBP was 0.624 and for mean DBP was 0.491. The bias for oscillometric BP measurement was 8.7 mm Hg for SBP (P < .01) and 5.7 mm Hg for DBP (P < .01). BP status classification agreement was 61% for SBP and 63% for DBP, with Kappa values of .31 for SBP and .20 for DBP.

Conclusions: Compared with auscultation, the oscillometric device significantly overestimated both SBP and DBP, leading to frequent misclassification of BP status.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Scatterplot (a) of the SBP oscillometric measures against their respective auscultatory measures; and Bland-Altman plot (b) of the least squares regression line (dashed line) of the paired difference in SBP (oscillometric-auscultatory) against the paired mean ((oscillometric+auscultatory)/2) in SBP.
Figure 2
Figure 2
Scatterplot (a) of the DBP oscillometric measures against their respective auscultatory measures; and Bland-Altman plot (b) of the least squares regression line (dashed line) of the paired difference in DBP (oscillometric-auscultatory) against the paired mean ((oscillometric+auscultatory)/2) in DBP.
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