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Blood Pressure Cuff Guidelines Not Consistent With Intra-arterial BP Meausrements in Pediatric Patients

Clark JA, Lieh-Lai MW, Sarnaik A, Mattoo TK. Discrepancies between direct and indirect blood pressure measurements using various recommendations for arm cuff selection. Pediatrics. 2002;110:920-923.


The National Heart, Lung, and Blood Institute Task Force on Blood Pressure Control in Children decided in 1996 to recommend that a child's blood pressure should be obtained using an arm cuff with a width of 40% of the upper arm circumference in the child. This was a revision of previous guidelines that stated that the cuff should be 3/4 of the arm surface (1987 criteria), and previously a 2/3 size criteria (1966 criteria). This study investigated whether the recommendation resulted in accurate blood pressure readings in children when compared to direct measurement using a radial intra-arterial blood pressure.


This study involved the measurement of blood pressure in 65 pediatric patients who were admitted to one pediatric intensive care unit. During their PICU stays, 172 blood pressure observations were made. The measurements were done by making three blood pressure measurements on each patient using each of the indirect measurement criteria based on the size of the blood pressure cuffs and then these data were compared to the radial intra-arterial blood pressure.


The findings showed that the 2/3 and 3/4 cuff sizes underestimated systolic blood pressures, while the 40% criterion showed no difference. This was consistent no matter the age or size of the patient. When assessing diastolic blood pressure, the 40% cuff size overestimated the pressure, while the other two cuffs underestimated the blood pressure. In short, none of the current or previous guidelines' cuffs produced similar blood pressure findings when the measurements were compared to the direct intra-arterial pressures. Again, the only measurement that came out the same was the 40% size with systolic pressures only.


The researchers concluded that the many types of blood pressure cuffs available and the inconsistent readings given by these cuffs when compared to direct readings make assessment of pediatric blood pressure a challenge. They recommend further study to find better selection criteria for blood pressure measurement tools for pediatric patients.


Janet T. Ihlenfeld RN, PhD


Janet T. Ihlenfeld, RN, PhD, is a Professor of Nursing at D'Youville College in Buffalo, NY.


Interpreter's Services Beneficial in Pediatric Emergency Departments

Hampers LC, McNulty JE. Professional interpreters and bilingual physicians in a pediatric emergency department. Effect on resource utilization. Arch Pediatr Adolesc Med. 2002;156:1108-1113.


Staff in emergency departments often care for families who do not speak English. The availability of interpreters may help in the care of sick children; however, there are no data to indicate the extent of the impact of the interpreters on their care. This study used a survey technique to query emergency room physicians on the extent that caring for non-English-speaking families had an impact on their care and whether the presence of interpreters helped ease the situation.


Data were collected in one pediatric emergency department in Chicago from October 1997 to May 1998 and from August 1999 to February 2000. Over that time, data from 4,146 visits from children who had fevers >38.5[degrees]C (52%) or had vomiting or diarrhea were gathered. Questionnaires were given to physicians to ask about their perception of the language ability of the family and whether barriers to health care existed based on the language and the use of the interpreter.


The findings showed that 9.2% of the families did not speak English and that this caused a barrier to care. About 4% more families did not speak English but they had access to other persons who could interpret for them. Most of the time, the language spoken primarily by the family was Spanish; however, families who spoke Polish, Russian, or Vietnamese were also represented. In the 239 cases who needed the interpreter, 90% were there for the initial diagnoses and interview, while 74% of the time they were there at discharge. Because interpreters were not present for all of the families who needed them, it was found that children in those families received more diagnostic tests, were admitted to the hospital more often, and received more conservative treatment than those who had interpreters. It was also found that patients who had interpreters spent a longer time in the emergency department than those who did not; however, further research would be needed to see if that made a difference in the total care.


The researchers recommended more interpreters be used in the emergency department because these data showed that the use of interpreters resulted in decreased costs in both treatment and family needs that were more than offset by the cost of providing the interpreters


Janet T. Ihlenfeld RN, PhD


Janet T. Ihlenfeld, RN, PhD, is a Professor of Nursing at D'Youville College in Buffalo, NY.