The arterial pressure auscultatory method: New approach for better cardiology teaching

Systemic arterial blood pressure is one of the most important parameters in clinical medicine, but it is inaccurately measured in most cases. The most common way to measure arterial pressure is the auscultatory method; however, this is strictly dependent on the operator, who must be able to coordinate their eyes, hands and ears in a well defined standard procedure. Operators should be assessed on their knowledge of the physical and physiological rules governing the method and should be properly trained in the practical skills to be applied on patients. Currently, international guidelines govern the correct training procedures and final evaluation methodology to assess the operator’s knowledge of the general technique and interpretation of measurements. This article proposes a new personal computer-based system to improve the clinical training in the auscultatory technique and to allow a simple evaluation of observers at the end of the training course. The new methodology consists of the digital acquisition and storage of the cuff pressure and Korotkoff sounds during a standard auscultatory pressure measurement and a subsequent recall of the stored signals to perform a more accurate measurement (by graphical approach on the monitor of the digital system), followed by comparison of results and critical analysis of the procedural phases. The feasibility of the method was evaluated on 40 medical students who, during their clinical training, performed pressure measurements using the standard auscultatory method. Results showed a mean absolute difference between pressures obtained directly and those obtained by post processing of 5 ± 3mm Hg for systolic values and 6 ± 3mm Hg for diastolic values, with a maximum underestimation of 16mm Hg for systolic blood pressure (SBP) and an overestimation of 15mm Hg for diastolic blood pressure (DBP). These values correspond to a mean percentage difference of 4% for SBP and 8% for DBP. The graphical analysis of the tracings allowed, in all cases, the detection of the possible causes of these differences, indicating the adequate procedural corrections.