Bruce N G, Shaper A G, Walker M, Wannamethee G
Department of Clinical Epidemiology and General Practice, Royal Free Hospital School of Medicine, London, UK.
J Hypertens. 1988 May;6(5):375-80.
Observer variation in blood pressure measurement following training with standard techniques has been investigated in a study of 7735 middle-aged men. The initial training produced consistent results between observers, but there were progressive deteriorations in the ensuing months. Subsequent re-training led to marked though inconsistent reductions in variation, but within 1 or 2 months, observers reverted back to an individual level of bias. The magnitude of observer variation is in line with the few other published accounts, and is sufficient to have important implications for group comparisons, clinical trials, and the clinical care of individual patients. Four methods of reducing observer variation are considered: regular re-training, self-measurement and ambulatory monitoring, automatic sphygmomanometers, and adjustment in the analysis. The adjustment procedure used in the British Regional Heart Study is described. Regular and frequent re-training with monitoring of performance, or the use of automatic machines are presently considered the two most practical methods of reducing observer variation.
在一项针对7735名中年男性的研究中，对采用标准技术培训后血压测量中的观察者变异进行了调查。初始培训使观察者之间的结果保持一致，但在随后的几个月里出现了逐渐恶化的情况。随后的再培训导致变异明显减少，尽管并不一致，但在1到2个月内，观察者又恢复到了各自的偏差水平。观察者变异的程度与其他少数已发表的报告一致，足以对组间比较、临床试验以及个体患者的临床护理产生重要影响。文中考虑了四种减少观察者变异的方法：定期再培训、自我测量和动态监测、自动血压计以及分析中的调整。描述了英国地区心脏研究中使用的调整程序。目前认为，定期且频繁地进行再培训并监测表现，或使用自动仪器是减少观察者变异的两种最实用的方法。
