Oscillometric and auscultatory blood pressure measurement methods in children: a systematic review and meta-analysis

Background: The phase-out of mercury from clinical settings calls for valid alternatives to assess blood pressure (BP) in children. Aneroid devices provide a mercury-free alternative to BP measurements by auscultation, whereas oscillometric (automated) devices are increasingly becoming the norm in clinical practice due to their ease of use. The aim of this systematic review and meta-analysis was to investigate the accuracy of oscillometric and aneroid BP devices compared with the mercury sphygmomanometer for the measurement of BP in children. Methods: We systematically searched four electronic databases (MEDLINE, Embase, CINAHL, and Web of Science) and relevant journals for eligible articles published before 30 July 2015. We screened 1415 articles, and two authors independently reviewed 92 full-text articles. Results: We included 29 articles (38 studies) with 26 879 children. Random-effects model meta-analyses revealed that oscillometric devices yield higher measurements of SBP than auscultation with a mercury sphygmomanometer (pooled effect estimate 2.53 mmHg; 95% CI 0.57-4.50; P<0.05); the pooled effect estimate for SBP was smaller in studies that 'passed' validation protocols (1.76 mmHg; 95% CI 0.61-2.81; n = 12). There was no significant difference for DBP (pooled effect estimate 1.55 mmHg; 95% CI -0.20 to 3.31). There was heterogeneity between studies, explained in part by differences in manufacturer, study setting and observer training. Only three studies compared BP using aneroid and mercury devices and found comparable results. Conclusion: Oscillometric devices may serve as a suitable alternative to auscultation for initial BP screening in the pediatric population.