...non-critically ill patients, BP is measured with noninvasive methods, such as manual sphygnomanometry or automated, oscillometric BP devices which offer indirect measurements of BP (Pickering et al., 2006).

Manual BP closely approximates direct arterial BP measurements (Byra-Cook, Dracup, Lazik, 1990; Norman, Gadaleta, & Griffin, 1991); however, significant differences in BP have been found between automated BP devices and manual or direct arterial BP measurements (Braam & Thien, 2005; Bur et al., 2000; Bur et al., 2003; Chang, Rabinowitz, & Shea, 2003; Cienke, DeLuca, & Daniel, 2004; Coe & Houghton, 2002; Davis et al., 2003; Parker & Steigerwalt, 2004; Shahriari, Rotenberg, Nielsen, Wiinberg, & Nielsen, 2003). One factor likely to account for the BP difference is that most automated BP devices detect oscillations, or movements, of the arterial wall rather than sounds created by blood flow in the artery (manual auscultation of BP) or pressure within the arterial system (intra-arterial BP) (van Montfrans, 2001). In addition, each manufacturer has different algorithms to identify systolic and diastolic pressures in the automated devices. Many of those algorithms require a regular interval between each cardiac cycle to estimate systolic and diastolic pressures properly. Consequently, clinical conditions that lead to changes in the arterial wall (athlerosclerosis) (Braam & Thien, 2005; van Montfrans, 2001; van Popele et al., 2000), hypotension (Davis et al., 2003), or hypertension (Braam & Thien, 2005), or result in irregular cardiac cycles (atrial fibrillation, premature beats, heart blocks) (Pickering et al., 2005), interfere with proper algorithm identification of BP, can lead to inaccuracies in BP measurement. Manufacturers' directions on proper use of automated devices (Criticon Inc., 1990), as well as guidelines from the American Heart Association and American Association of Critical-Care Nurses (Giuliano, 2005; Pickering et al., 2005), highlight the need to use carefully and/or avoid use of the automated devices in patients with cardiac dysrhythmias, atherosclerosis, and/or with high or low BP.

Despite device design limitations and laboratory and clinical research findings, the ease of use of the automated devices for BP measurement has led to widespread use of these devices in acute care hospitals. While manufacturers have made significant design improvements over the years which may have improved their accuracy, limited research is available on the performance of these devices in clinical practice.

The purpose of this study was to determine the accuracy of an automatic, electronic BP device as compared to a manual sphygmomanometer BP device in acute care medical patients.

Materials and Methods

This study was approved by the institutional review board and conducted on a medical unit of a 483-bed, nonprofit community hospital in the Pacific Northwest.

Study design. A method-comparison study design was used to evaluate two different methods for BP determination: manual and automatic. Each subject served as his or her own control and manual and automatic BP measurements taken sequentially, with the order determined by random assignment with a computer-generated program. The primary dependent variable was...

NOTE: All illustrations and photos have been removed from this article.



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