Published online September 1, 2008
PEDIATRICS Vol. 122 No. 3 September 2008, pp. e590-e594 (doi:10.1542/10.1542/peds.2008-0812)
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ARTICLE

Interrater Reliability and Effect of State on Blood Pressure Measurements in Infants 1 to 3 Years of Age

Andrea F. Duncan, MDa, Charles R. Rosenfeld, MDa, Janet S. Morgan, RNa, Naveed Ahmad, MD, MPHb and Roy J. Heyne, MDa

a Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
b Department of Clinical Research, Children's Medical Center of Dallas, Dallas, Texas

OBJECTIVE. The objective of this study was to determine the interrater variability and effect of state on systolic blood pressure measurements in infants ≤3 years of age.

METHODS. Study 1 examined interrater variability, determined by interclass correlation coefficient for 2 raters, and the effect of state on systolic blood pressure measurements in infants at 1, 2, and 3 years. Study 2 examined the variability of duplicate systolic blood pressure measurements by a single rater determined by interclass correlation coefficient and effect of state in 120 infants at 1, 2, and 3 years. Systolic blood pressure was defined as the Doppler-amplified sound corresponding to the first Korotkoff sound using a sphygmomanometer with appropriate cuff size. State was scored as follows: 1, sleeping; 2, awake and calm; 3, awake and fussy/restless; and 4, awake and vigorously crying/screaming.

RESULTS. In study 1, the overall interclass correlation coefficient for systolic blood pressure was 0.81 and decreased when state varied between raters. When compared with a calm state 1 and/or 2 at both measurements, noncalm state 3 and/or 4 at both measurements was associated with an increase in systolic blood pressure. Although state was similar in infants born at ≤36 and >36 weeks' gestational age, the former had a systolic blood pressure 13.0 ± 14 mm Hg greater than the 50th centile for age and gender versus 2.4 ± 12 mmHg for those >36 weeks' gestation. In study 2, the interclass correlation coefficient for repeated measurements by a single rater was 0.85, and noncalm state at both measurements was associated with an elevated systolic blood pressure.

CONCLUSIONS. Systolic blood pressure can be accurately measured in the first 3 years after birth, but state modifies systolic blood pressure and must be determined at the time of measurement. Infants born at ≤36 weeks' estimated gestational age may be at risk for an elevated systolic blood pressure, but this requires additional study.

Key Words: systolic blood pressure • validation • infant state • preterm • follow-up

Abbreviations: BP—blood pressure • VLBW—very low birth weight • SBP—systolic blood pressure • ICC—intraclass correlation coefficient • EGA—estimated gestational age • CI—confidence interval

Accepted May 22, 2008.


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eLetters:

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Effect of State on Blood Pressure Measurements in Infants
Vincenzo Zanardo, et al.
Pediatrics Online, 20 Sep 2008 [Full text]