Morcos Roy N, Carter Kimbroe J, Castro Frank, Koirala Sumira, Sharma Deepti, Syed Haroon
From the Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH (RNM, SK); Department of Family Medicine Residency Program, St. Elizabeth Boardman, Mercy Health (RNM); Medical Decision Making Society of Youngstown Ohio, c/o Jeghers Medical Index, St. Elizabeth Youngstown Hospital, Youngstown, OH (FC, KJC); Family Medicine Residency Program, St. Elizabeth Boardman, Mercy Health (SK, DS); Department of Pathology, Northeast Ohio Medical University, Rootstown, OH (KJC).
J Am Board Fam Med. 2019 Sep-Oct;32(5):732-738. doi: 10.3122/jabfm.2019.05.190085.
To evaluate 2 commonly overlooked sources of error in measuring blood pressure (BP) in the office, improper patient positioning and frequency of terminal digit bias (TDB) using manual and automated (BP) devices.
BPs recorded by 3 nurses using manual and automated devices were analyzed for TDB. In the next part of the study, 294 patients were recruited and tested with each patient's BP measured twice in the table position and compared with BP measured in the chair position. To eliminate concern for position sequence, a randomized controlled trial was initially conducted.
Significant TDB for the digit zero was identified in BPs measured by all nurses using a manual device. No such bias was identified for any nurse when measuring BP with an automated device. For the positional study, the randomized controlled study showed no significant sequencing effect therefore the sequence of table then chair BP measurements was adopted. Significant BP lowering was observed in 128 patients (42.7%) in the chair compared with the table position. Misclassification of prehypertension and hypertension would have occurred in 15.3% and 16% of patients, respectively, when BP was recorded in the table instead of the chair position.
Significant TDB was identified for all nurses when using a manual but not an automated device. Patient positioning on the examination table resulted in elevations of systolic and diastolic BPs.
评估在诊室测量血压（BP）时两个常被忽视的误差来源，即患者体位不当以及使用手动和自动血压测量设备时终位数字偏倚（TDB）的频率。
分析3名护士使用手动和自动设备记录的血压数据以检测TDB。在研究的下一部分，招募了294名患者并进行测试，每位患者在平卧位测量两次血压，并与在坐位测量的血压进行比较。为消除对测量顺序的担忧，最初进行了一项随机对照试验。
所有护士使用手动设备测量血压时，均发现数字零存在显著的TDB。使用自动设备测量血压时，未发现任何护士存在此类偏倚。对于体位研究，随机对照研究显示无显著的顺序效应，因此采用先平卧位后坐位测量血压的顺序。与平卧位相比，128名患者（42.7%）在坐位时血压显著降低。当在平卧位而非坐位记录血压时，分别有15.3%和16%的患者会出现高血压前期和高血压的误诊。
所有护士使用手动设备而非自动设备时均发现显著的TDB。患者在检查台上的体位会导致收缩压和舒张压升高。
