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In-use comparison of blood pressure measurements from an automated blood pressure instrument with those from a mercury sphygmomanometer.

In addition to its ease of use and degree of independence from the subjectivity inherent in measurements made with the mercury sphygmomanometer (HgS), automated blood pressure measurement instruments (ABPMI) obviate the use of mercury-containing instrumentation and the attendant environmental issues. Thus, they have been widely used in healthcare facilities worldwide. Most evaluations of ABPMI have focused on their compliance with established international protocols, and there has been a paucity of studies examining their performance in actual use in healthcare facilities. The purpose of this study was to evaluate the ABPMI used in our institution--a large, urban, tertiary-care teaching hospital in the northeastern United States--under routine conditions. This device, the Dinamap ProCare 400 Monitor, was compared to HgS (considered the "gold standard" for non-invasive blood pressure measurement) with respect to key analytical variables, i.e., precision of measurements and correlation within a large (n=300) sample of patients. Several sources of observer bias with HgS were detected. Precision varied among parameter (systolic blood pressure [SBP]; diastolic blood pressure [DBP]; and mean arterial pressure [MAP]) and level (normotensive, moderately hypertensive, and severely hypertensive). Correlation and regression suggested a strong association between the methods and Bland-Altman analysis indicated an acceptably small systematic error (bias) but greater random error than that demonstrated by previous evaluations with international test protocols. We recommend that healthcare facilities evaluate ABPMI under actual conditions and that formal protocols be established for these evaluations under routine conditions of patient care.