Photo Credit: Liudmila Chernetska
The following is a summary of “Accuracy and Performance of Triage Blood Pressure Measurements in a Real-World Clinic Setting,” published in the February 2024 issue of Pediatrics by Wen al.
This study aimed to assess the concordance and precision of triage blood pressure (BP) readings in a real-world clinic setting compared to a standardized reference.
Researchers conducted a retrospective chart review of paired triage and standardized BP measurements from patients aged 4 to 21 years attending an obesity-related hypertension clinic. Triage BPs were typically obtained by a medical assistant or nurse, often using an automated device, while clinic physicians obtained triplicate manual BPs. Bland-Altman analyses determined the mean differences between paired triage and mean standardized BPs. Additionally, GEE-based multivariable relative risk regression was used to determine the risk of overestimating triage BP by ≥5mmHg. Overall agreement, sensitivity, specificity, positive predictive value, and negative predictive value of triage BP measurements for identifying hypertensive BP were assessed.
A total of 130 participants with 347 clinic encounters were included in the study, with a mean age of 13.3 years (standard deviation 3.94), 76% Black, and 58% male. The mean systolic BP difference was 8.7 mmHg (95% limits of agreement: -16.66, 34.07), and the mean diastolic BP difference was 4.1 mmHg (95% limits of agreement: -18.56, 26.68). Triage systolic BP was more likely to be overestimated by ≥5 mmHg when a large adult cuff (RR=1.49; 95%CI: 1.00, 2.21) or thigh cuff (RR=1.94; 95%CI: 1.08, 3.51) was required compared to when a child/adult cuff was used. Overall agreement in identifying hypertensive BP was 57.6%, with low sensitivity (52.6%), specificity (63.4%), positive predictive value (60.8%), and negative predictive value (55.3%) across all cuff types.
Their findings reveal poor agreement between routine triage and standardized BP measurements, indicating potential clinical implications.
Source: sciencedirect.com/science/article/abs/pii/S0022347624000659
