Correlation between invasive and noninvasive blood pressure measurements in severely burned children

Introduction: Accurate blood pressure monitoring is essential for burn management, with the intra-arterial line method being the gold standard. Here we evaluated agreement between cuff and intra-arterial line methods. Methods: Data from burned children admitted from 1997 to 2016 were retrospectively reviewed. Simultaneously collected intra-arterial and cuff measurements were cross-matched and linear regression performed to assess agreement for systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP). Results: We identified 9969 matches for SBP, DBP, and MAP in 872 patients (579 male) aged 8 ± 5 years with burns covering 52 ± 20% of the total body surface area and a hospitalization lasting 33 ± 31 days. Intra-arterial lines had a complication rate of 1%. The mean bias (95% CI) between methods was 1.3 (0.5, 2.1) mm Hg for SBP, −6.4 (−7.0, −5.7) mmHg for DBP, and −5.8 (−6.4, −5.3) mmHg for MAP. The standard deviation of the bias (95% limit of agreement) was 12.1 (−22.5, 25.1) mmHg for SBP, 9.9 (−25.8, 13.0) mmHg for DBP, and 8.7 (−22.8, 11.1) mmHg for MAP. Conclusions: Cuff measurements vary widely from those of intra-arterial lines, which have a low complication rate. Intra-arterial lines are advisable when tight control of the hemodynamic response is essential.