Ripollés Ortí M, Martín Rioboó E, Díaz Moreno A, Aranguren Baena B, Murcia Simón M, Toledano Medina A, Fonseca Del Pozo F J
Centro de Salud Huerta de la Reina, Córdoba.
Aten Primaria. 2001 Mar 15;27(4):234-43. doi: 10.1016/S0212-6567(01)78802-6.
To assess reliability in terms of inter-observer agreement of blood pressure (BP) readings. Various health professionals and measuring systems. Influence of observer's experience.
Observational, descriptive, cross-sectional study.
Urban health centre, Córdoba.
131 hypertensive, randomised patients, belonging to a functional care unit. 11 were excluded.
To reduce variability: course on the right way to take blood pressure, otoscope and verification of visual sharpness of observers, calibration and validation of measuring devices, limited time and blinding of measurements. 4 BP measurements per patient: 3 with mercury sphygmomanometer (2 simultaneously, one individual) and one with an automatic device. Descriptive, clinical and somatometric variables were gathered. Inter-observer agreement was evaluated through the intraclass correlation coefficient (ICC), the mean of differences method (MDM) and the simple concordance index (CI). An ICC > 0.75 was thought acceptable. A difference > 5 mmHg was thought clinically relevant (MDM and CI).
Acceptable consistency for MDM: alone, systolic and diastolic pressure of OBS 1/ OBS 2, bi-auricular, -6.1/+8.9 mmHg and -6.8/+5.8 mmHg. Less favourable results: for systolic and diastolic pressure: OBS 1/AUTO -20.9/25.0 and -16.4/15.1; OBS 2/AUTO -22.8/24.4 and -16.6/15.2. Remaining intervals always > 10 mmHg; CI > 0.75 in all comparisons except diastolic pressure OBS 1/AUTO and diastolic pressure OBS 2/AUTO (0.69 in both cases). 41% of comparisons were > 5 mmHg. No differences in less expert professionals were found.
Inaccuracy of the standard BP measurement method (mercury sphygmomanometer) for MDM and CI. Contradictory conclusions according to method of measurement. Differences not clinically acceptable.
根据血压（BP）读数的观察者间一致性评估可靠性。涉及各种卫生专业人员和测量系统。以及观察者经验的影响。
观察性、描述性横断面研究。
科尔多瓦的城市健康中心。
131名高血压随机患者，隶属于一个功能护理单元。排除11名。
为减少变异性：开展关于正确测量血压方法的课程、使用耳镜并检查观察者视力、校准和验证测量设备、限定时间以及测量时设盲。每位患者测量4次血压：3次使用汞柱式血压计（2次同时测量，1次单独测量），1次使用自动设备。收集描述性、临床和人体测量学变量。通过组内相关系数（ICC）、差异均值法（MDM）和简单一致性指数（CI）评估观察者间一致性。ICC>0.75被认为可接受。差异>5 mmHg被认为具有临床相关性（MDM和CI）。
MDM的一致性可接受：单独测量时，OBS 1/OBS 2的收缩压和舒张压，双耳测量，-6.1/+8.9 mmHg和-6.8/+5.8 mmHg。结果不太理想的情况：收缩压和舒张压方面：OBS 1/AUTO为-20.9/25.0和-16.4/15.1；OBS 2/AUTO为-22.8/24.4和-16.6/15.2。其余区间始终>10 mmHg；除舒张压OBS 1/AUTO和舒张压OBS 2/AUTO外（两者均为0.69），所有比较中的CI>0.75。41%的比较差异>5 mmHg。未发现经验较少的专业人员存在差异。
标准血压测量方法（汞柱式血压计）在MDM和CI方面不准确。根据测量方法得出相互矛盾的结论。差异在临床上不可接受。
