Key result
Radial pulse palpation with history improves clinically acceptable systolic blood pressure estimation by ~39 percentage points.
Why the study?
The accuracy and clinical utility of anaesthesia clinicians estimating an anaesthetised patient's systolic blood pressure by feeling the radial pulse, and whether performance reflects luck, skill, or circumstance, needed evaluation.
RCT (n=248)
Single-blind (participants blinded to true SBP Dinamap read-out)
Sequential randomization in 1:1:1:1 ratio using opaque envelopes
No
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Radial pulse palpation with history improves SBP estimation accuracy; supports clinical adoption and further outcome trials.
The trial assessed the accuracy of anaesthesia clinicians in estimating an anaesthetised patient's systolic blood pressure (SBP) by feeling the radial pulse.To credit their accuracy to luck, skill or circumstance, the volunteer medical participants were sequentially randomized to one of four groups: one group given no help (control), the second allowed to feel the pulse, the third given pre-and peri-operative clinical information, the fourth given both.We set out to collect 60 estimates for each group (240 estimates).The accuracy of their estimations was assessed to clinical and statistical significance.Specific objectives were to determine whether palpation statistically improved estimation of SBP and whether it could be clinically useful.Irrespective of the level of training or self-confidence, the doctors in the study performed better statistically against controls and to within pre-determined clinical relevance ranges when they were allowed to palpate the radial pulse.The degree of accuracy was enhanced by giving pre-and peri-operative information to the extent that the participant clinicians were able to estimate the systolic blood pressure to within 30mmHg accuracy 96.7% of the time.
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Brenton R. Clarke (2018) conducted an RCT in Systolic blood pressure estimation in adult surgical patients under general anaesthesia (n=248). Radial artery pulse palpation combined with pre- and peri-operative clinical history vs. Control (guess-work without pulse palpation or clinical history) was evaluated on Clinically acceptable systolic blood pressure estimation (within 30 mmHg of true SBP) (p=<0.002). Radial pulse palpation with clinical history enabled clinicians to estimate systolic blood pressure within 30 mmHg 96.67% of the time vs 57.37% for controls (p<0.002).
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