title: Observer variability of Osler's maneuver in detection of pseudohypertension.
abstract: Pseudohypertension in the elderly occurs when blood pressure is overestimated because of inelastic, sclerotic arteries. Osler's maneuver (OM), the palpability of a pulseless artery, is recommended as a non-invasive test to detect pseudohypertension, despite limited data concerning its reproducibility. We assessed the maximum achievable inter-and intra-observer agreement of OM among 6 examiners: cardiologists, geriatricians and general internists. Each examiner performed OM twice on 65 elderly hypertensive men attending the general medicine and geriatric clinics. The inter-observer agreement for brachial and radial examinations was 79 and 70%, while intra-observer agreement was 82 and 75%, respectively. After adjusting for chance agreement the kappa values for inter-observer agreement for brachial and radial arteries were 0.38 (95% confidence interval (CI): 0.21-0.55) and 0.37 (0.28-0.46), respectively. Similarly, the kappa values for intra-observer agreement were 0.45 (95% CI: 0.35-0.55) and 0.49 (0.39-0.59). Kappa values never exceeded 0.6 in any time period, suggesting no training effect. OM cannot be recommended as a screening test for pseudohypertension given this low inter- and intra-observer agreement.
authors.affiliation: Ambulatory Care Service, Durham Department of Veterans Affairs Medical Center NC.
authors.forename: K M
authors.initials: KM
authors.lastname: Hla
authors.forename: G P
authors.initials: GP
authors.lastname: Samsa
authors.forename: H T
authors.initials: HT
authors.lastname: Stoneking
authors.forename: J R
authors.initials: JR
authors.lastname: Feussner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001916:Brachial Artery; D003627:Data Interpretation, Statistical; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D015588:Observer Variation; D010173:Palpation; D011446:Prospective Studies