title: Level of Agreement Between Forearm and Upper Arm Blood Pressure Measurements in Patients With Large Arm Circumference.
abstract: OBJECTIVE
  The purpose of the study was to determine if forearm blood pressures (BPs) measured in three different locations agree with the recommended upper arm location for noninvasive BP measurement.
  
  
  METHODS
  A method-comparison design was used.
  
  
  METHODS
  In a convenience sample of postanesthesia care unit patients with large upper arm circumference, BP's were obtained in three different forearm locations (lower forearm, middle forearm, and upper forearm) and compared to upper arm BP using an automated BP measuring device. The level of agreement (bias ± precision) between each forearm location and the upper arm BP was calculated using standard formulas. Acceptable levels of agreement based on expert opinion were set a priori at bias and precision values of less than ±5 mm Hg (bias) and ±8 mm Hg (precision).
  
  
  RESULTS
  Forty-eight postanesthesia patients participated in the study. Bias and precision values were found to exceed the acceptable level of agreement for all but one of the systolic and diastolic BP comparisons in the three forearm BP locations. Fifty-six percent of all patients studied had one or more BP difference of at least 10 mm Hg in each of the three forearm locations, with 10% having one or more differences of at least 20 mm Hg.
  
  
  CONCLUSIONS
  The differences in forearm BP measurements observed in this study indicate that the clinical practice of using a forearm BP with a regular-sized BP cuff in place of a larger sized BP cuff placed on the upper arm in postanesthesia care unit patients with large arm circumferences is inappropriate. The BPs obtained at the forearm location are not equivalent to the BPs obtained at the upper arm location.
authors.forename: Sheri
authors.initials: S
authors.lastname: Watson
authors.forename: Marita
authors.initials: M
authors.lastname: Aguas
authors.forename: Pat
authors.initials: P
authors.lastname: Colegrove
authors.forename: Nancy
authors.initials: N
authors.lastname: Foisy
authors.forename: Bonnie
authors.initials: B
authors.lastname: Jondahl
authors.forename: Zoe
authors.initials: Z
authors.lastname: Anastas
mesh_terms: D000886:Anthropometry; D001132:Arm; D001795:Blood Pressure Determination; D006801:Humans; D016528:Postanesthesia Nursing; D011997:Recovery Room; D015203:Reproducibility of Results
keywords: blood pressure location; forearm blood pressure; large blood pressure cuffs; large size arms; noninvasive blood pressure