Vital signs in hospital patients: a systematic review
International Journal of Nursing StudiesPublished 1 December 2001
David Evans, Brent Hodgkinson, Judith Berry
Citations124
SJR quartileQ1
SJR score2.82
SNIP3.21
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TL;DR
A review of vital sign measurements in hospital patients has highlighted a need for further investigation of issues related to the role, nature and optimal practice of monitoring patient vital signs.
Abstract
This review has highlighted a need for further investigation of issues related to the role, nature and optimal practice of monitoring patient vital signs.
Keywords
Health Professions
JAMAHow Common Is White Coat Hypertension?
1,171 Citations1988Thomas G. Pickering
Twenty-one percent of 292 patients with untreated borderline hypertension were found to have normal daytime ambulatory pressures, and patients with white coat hypertension were defined as having "white coat" hypertension, and they were more likely to be female and younger, to weigh less, and to be more recently diagnosed.
The LancetEFFECTS OF BLOOD-PRESSURE MEASUREMENT BY THE DOCTOR ON PATIENT'S BLOOD PRESSURE AND HEART RATE
745 Citations1983Giuseppe Mancia
HypertensionAlerting reaction and rise in blood pressure during measurement by physician and nurse.
486 Citations1987Giuseppe Mancia, Gianfranco Parati +4 more
The results indicate that the error of overestimation of blood pressure inherent in cuff blood pressure measurement by a physician cannot be avoided by repeated visits by the physician over a short time span, but it clearly can be reduced, however, if blood pressure measurements are performed by a nurse.
The LancetERROR IN BLOOD-PRESSURE MEASUREMENT DUE TO INCORRECT CUFF SIZE IN OBESE PATIENTS
308 Citations1982M H Maxwell, P Schroth +3 more
The reported high prevalence of hypertension in obese subjects may be greatly overestimated because of the measurement error caused by cuffs of inappropriate size at various ACs.
PEDIATRICSPulse Oximetry as a Fifth Pediatric Vital Sign
178 Citations1997William R. Mower, Carolyn J. Sachs +2 more
Using pulse oximetry as a routine fifth vital sign in acute pediatric assessment resulted in important changes in the treatment of a small proportion of pediatric patients.
Anesthesia & AnalgesiaContinuous Monitoring of Arterial Oxygen Saturation with Pulse Oximetry during Transfer to the Recovery Room
135 Citations1985I. L. Tyler, Boonrak Tantisira +2 more
CHEST JournalRoutine Oximetry
134 Citations1988Thomas A. Neff
Often, advances in medical technology become available on a widespread basis before a controlled scientific experience has accumulated to carefully delineate the indications, uses, and pitfalls of such technology, and this certainly is the case with pulse oximetry.
Journal of the Autonomic Nervous SystemBlood pressure variability
133 Citations1980Gianfranco Parati, Elena Tortorici +7 more
Survey of AnesthesiologyContinuous Monitoring of Arterial Oxygen Saturation with Pulse Oximetry During Transfer to the Recovery Room
132 Citations1986I. L. Tyler, Boonrak Tantisira +2 more
There was a statistically significant correlation between hypoxemia and obesity, and all three patients with a history of mild asthma became severely hypoxemic even though none had perioperative evidence of obstructive disease.
New England Journal of MedicineEffect of Vertical Displacement of the Arm on Indirect Blood-Pressure Measurement
127 Citations1964Paul Mitchell, R. Willis Parlin +1 more
Use of the technic in descriptive and experimental studies in large population groups such as those directed from this laboratory imposes greater demands on this clinical tool than those required for adequate evaluation of individual patients in the clinic.
American Heart JournalThe error in indirect blood pressure measurement with the incorrect size of cuff
121 Citations1978L. A. Geddes, S.J. Whistler
This paper shows the error to be expected when blood pressure is measured indirectly with a cuff that is too wide or too narrow for the member to which it is applied.
CirculationMiscuffing: inappropriate blood pressure cuff application.
116 Citations1983David Manning, C Kuchirka +1 more
Monitoring staff's cuff applications, it is found that "miscuffing" occurred in 65 (32%) of 200 BP determinations on 167 unselected adult outpatients, including 61 (72%) of 85 readings taken on "nonstandard" size arms.
JAMAThe New Vital Sign
109 Citations1991Michael C. Fiore
American medicine is challenged by a different cause of illness and death—tobacco use and institutional changes in the practice of medicine must be adopted to overcome the enormous disease burden resulting from tobacco use.
Archives of Disease in ChildhoodRespiratory rate: measurement of variability over time and accuracy at different counting periods.
108 Citations1991E A Simoes, Rick M. Roark +3 more
The data from this study suggest that one minute's counting either at a stretch or in two blocks of 30 second intervals is better than counting the respiratory rate for 30 seconds, when the child is either awake and calm or when asleep.
HypertensionEvaluation of the Technique Used by Health-Care Workers for Taking Blood Pressure
102 Citations1995Iván Villegas, Isabel C. Arias +2 more
A descriptive and observational study carried out in a major hospital to validate the precise guidelines recommended by the American Heart Association for blood pressure measurement, which found that health-care workers generally take blood pressure in an arbitrary way.
BMJInfluence of arm position on measurement of blood pressure.
99 Citations1984John Webster, D M Newnham +2 more
PubMedIncluding smoking status as a new vital sign: it works!
84 Citations1995Mark D. Robinson, Stéphane Laurent +1 more
Journal of HypertensionVariation in Cuff Blood Pressure in Untreated Outpatients with Mild Hypertension - Implications for Initiating Antihypertensive Treatment
79 Citations1987R. Douglas Watson, Rosemary Lumb +4 more
Journal of Emergency MedicineRespiratory rates in emergency department patients
73 Citations1989Edmond A. Hooker, Daniel J. O’Brien +3 more
It is concluded that the "normal" respiratory rate may be higher than that suggested in the medical literature, and based on a review of the literature concerning what constitutes a 'normal' respiratory rate, this study evaluated " normal" respiratory rates in 110 emergency department patients.
CHEST JournalEffect of Routine Emergency Department Triage Pulse Oximetry Screening on Medical Management
72 Citations1995William R. Mower, Carolyn J. Sachs +3 more
Providing physicians with routine triage pulse oximetry measurements resulted in significant changes in medical treatment of these patients, including hospital admission and final diagnoses that occurred after disclosure of pulse oxIMetry values.
Journal of General Internal MedicineThe white-coat hypertension response
68 Citations1989Caryn Lerman, David S. Brody +4 more
Patients with white-coat hypertension did not have greater blood pressure reactivity in their natural environments, suggesting that their blood pressure elevations may be specific to the medical setting.
JAMAThe Charlottesville Blood-Pressure Survey
66 Citations1976Robert M. Carey
Labile hypertension represents a large segment of the population initially identified as having hypertension in a home blood-pressure survey and was most prevalent in the young and decreased with age, and sustained hypertension was more prevalent in blacks than in whites.
Respiratory MedicineA comparison of pulse oximetry and respiratory rate in patient screening
64 Citations1996William R. Mower, Carolyn J. Sachs +3 more
Respiratory rate measurements correlate poorly with oxygen saturation measurements and do not screen reliably for desaturation, and increased RR is unlikely to reflect desaturation.
Acta Medica ScandinavicaTHE ACCURACY OF AUSCULTATORY MEASUREMENT OF ARM BLOOD PRESSURE IN VERY OBESE SUBJECTS
62 Citations1974Poul Ebbe Nielsen, Hanne Janniche
In patients in whom “cuff hypertension” is suspected, intraarterial measurements are indicated before prolonged antihypertensive treatment is initiated, because big interindividual differences nevertheless exist which cannot be predicted from the BP nor the circumference of the arm.
Clinical PediatricsThe Impact of Moderate Ambient Temperature Variance on the Relationship Between Oral, Rectal, and Tympanic Membrane Temperatures
55 Citations1991Wm. John Zehner, Thomas E. Terndrup
The effect of moderate ambient temperature variance on the relationship between oral (OT), rectal (RT), and tympanic membrane (TMT) temperature in 21 healthy adults is examined to conclude that OT and TMT have a predictable relationship to RT at normal ambient temperature.
BMJAccuracy of auscultatory blood pressure measurement with a long cuff.
53 Citations1987Gert A. van Montfrans, G M van der Hoeven +3 more
It is suggested that auscultatory blood pressure may be measured with acceptable accuracy with a single long bladdered cuff both in subjects with large arms and in Subjects with normal sized arms.
Annals of Emergency MedicineOrthostatic vital signs in emergency department patients
51 Citations1991Jane Koziol‐McLain, Steven R. Lowenstein +1 more
The data from this study indicate that there is a wider than expected variation in orthostatic vital signs among presumed euvolemic ED patients.
The American Journal of Emergency MedicineThe effect of ambient temperature extremes on tympanic and oral temperatures
50 Citations1992F. W. Doyle, Wm. John Zehner +1 more
Tympanic and oral temperatures taken within the first 20 minutes after exposure to outdoor temperature extremes may fail to accurately reflect the patient's true temperature.
Journal of Emergency MedicineImpact of operator technique and device on infrared emission detection tympanic thermometry
50 Citations1992Thomas E. Terndrup, Joanne Rajk
In a prospective, blinded trial, 40 healthy adult subjects using six IRED thermometers with two techniques were examined in random sequence and differences between IRED tympanic, oral, and rectal temperatures were compared using ANOVA.
Acta Medica ScandinavicaVALIDITY OF BLOOD PRESSURE MEASUREMENT WITH CUFF IN THE ARM AND FOREARM
50 Citations1970S. Å. Forsberg, Maria de Guzman +1 more
There was a big difference between intraarterial and cuff systolic or diastolic pressure, but use of the standard cuff on the forearm gave good results in extremely obese patients necessitating the use of a big cuff.
The American Journal of SurgeryThe sensitivity of vital signs in identifying major thoracoabdominal hemorrhage
49 Citations1989Gregory K. Luna, A. Craig Eddy +1 more
It is concluded that normal postinjury vital signs do not predict the absence of potentially life-threatening hemorrhage and abnormal vital signs at any point after injury require investigation to rule out significant blood loss.
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49 Citations1983P. E. Nielsen, B. Larsen +2 more
In 59 treated or untreated hypertensive subjects and 52 obese subjects (normotensive or hypertensive), intraarterial blood pressure was compared to simultaneous auscultatory measurements, and it was emphasized that there is a wide scatter in the interindividual differences.
The American Journal of Emergency MedicinePulse oximetry to identify a high-risk group of children with wheezing
46 Citations1989Linda Rosén, Loren G. Yamamoto +1 more
Pulse oximetry may be useful in identifying children with wheezing who are at high risk, as demonstrated by the need for hospitalization, during the early phase of an ED encounter, at which time more aggressive therapeutic interventions may be considered.
Academic Emergency MedicineCerumen Occlusion Lowers Infrared Tympanic Membrane Temperature Measurement
44 Citations1995David Doezema, Margaret Lunt +1 more
Cerumen occlusion of the ear canal causes underestimation of body temperature measure by infrared tympanic membrane thermometry.
The American Journal of Emergency MedicineOrthostatic vital signs: Variation with age, specificity, and sensitivity in detecting a 450-mL blood loss
42 Citations1992Larry J. Baraff, David L. Schriger
Pulse rate increase was the most sensitive of the orthostatic vital signs used alone and a pulse rise of greater than 20 beats per minute had a sensitivity of 9% with a specificity of 98%.
PubMedThe importance of cuff width in measurement of blood pressure indirectly.
41 Citations1976L. A. Geddes, R Tivey
Data reveal the fundamental nature of the effect of the ratio of cuff width to member circumference with respect to the accuracy of indirect blood pressure measurements and the order of error expected with narrow and wide cuffs is discussed.
JAMASphygmomanometric Cuff Size and Blood Pressure Recordings
40 Citations1973George E. Burch
In a group of 50 adult patients, indirect blood pressure recordings were obtained with nine Velcro self-adhesive cuffs of varying widths and lengths and it was shown that the width of the air-inflatable bladder is important and should be 12 to 14 cm.
PubMedAccuracy of heart rate assessment in atrial fibrillation.
38 Citations1992Nancee V. Sneed, Ann D. Hollerbach
Atrial fibrillation occurs in 2% to 4% of people over 60 years of age and is one of the most difficult dysrhythmias to count, yet measurement of heart rate in this study was quite inaccurate.
Preventive MedicineQuality of Korotkoff sounds: Bell vs diaphragm, cubital fossa vs brachial artery
35 Citations1983Ronald J. Prineas, David R. Jacobs
Comparison of clarity of Korotkoff sounds was made between those heard with the bell or diaphragm of the stethoscope andbetween those heard over the cubital fossa or more proximally and medially over the maximal brachial artery pulse--during indirect sphygmomanometry.
Annals of Emergency MedicineImpact of portable pulse oximetry on arterial blood gas test ordering in an urban emergency department
34 Citations1991Arthur Kellerman, Cynthia A Cofer +2 more
Routine use of portable pulse oximetry may substantially reduce rates of ABG testing and associated patient charges without adversely affecting the quality of emergency care.
Postgraduate Medical JournalBlood pressure variability: the effects of repeated measurement
34 Citations1981P. G. Burstyn, Barbara O’Donovan +1 more
People whose BP dropped substantially between the 1st and 2nd visits achieved higher anxiety scores on a questionnaire than did the remainder of the sample, which may partially explain their labile BP.
Archives of Disease in ChildhoodMarkers of serious illness in infants under 6 months old presenting to a children's hospital.
28 Citations1990Peter Hewson, S M Humphries +3 more
Six hundred and eighty two assessments were performed on 641 babies under 6 months of age who presented to the emergency department of the Royal Children's Hospital, Melbourne to try and determine the best markers of serious illness in young infants.
Medical CareProcedures and Discrepancies of Blood Pressure Measurements in Two Community Health Centers
27 Citations1982Larry Scherwitz, Lynn A. Evans +2 more
There was little correlation between potential biases in providers' procedures and discrepanices with the standard, and the discrepancies between the nurse and physician readings led to different treatment indicators in 22-26% of the observations.
PEDIATRICSThe Newborn's Spo2: A Routine Vital Sign Whose Time Has Come?
25 Citations1995Gerald H. Katzman
It is recommended that temperature, heart and respiratory rates, skin color, adequacy of peripheral circulation, type of respiration, level of consciousness, tone, and activity be monitored every 30 minutes until the newborn's condition has remained stable for 2 hours.
Research in Nursing & HealthIndirect auscultatory blood pressure measurement at two sites in the arm
23 Citations1985Barbara J. Tachovsky
Differences in data obtained at the two sites are explored on 98 female subjects, aged 18 to 25 years, with nonobese arms and without history of cardiovascular-renal disease, indicating that statistically significant differences exist between the sites based on the lower systolic values and higher diastolic values obtained atThe forearm site.
Journal of Nursing EducationNursing Student Compliance to Standards for Blood Pressure Measurement
22 Citations1993Barbara Bogan, S Kritzer +1 more
Responses to the questionnaire revealed that factors of logistics and attitudes of others influence student compliance or at least make the situation less conducive to adhering to the AHA standards.
Research in Nursing & HealthThe Influence of Talking on Diastolic Blood Pressure Readings
20 Citations1984Rosemary Hellmann, S. Grimm
Investigating the effect of talking on diastolic blood pressure found blood pressure increased significantly under both talking conditions, and implications for nursing education, practice, and future research are discussed.
Postgraduate Medical JournalA critical look at nursing observations
20 Citations1990Janet Burroughs, B I Hoffbrand
It is shown that whilst a majority of nurses questioned believe in the importance of routine observations for patient care, there is a lack of consistency in the criteria and communication procedures used that must seriously limit the value of the information obtained by the individual nurse.
Emergency Medicine JournalPulse oximetry in the accident and emergency department.
20 Citations1989C. J. Holburn, Maria Allén
The experience shows that the pulse oximeter may be a useful tool for evaluating hypoxia and oxygen therapy in the accident and emergency department and the groups who should reply in the positive to Zorab's question, 'Who needs pulse oximetry?' are felt.
Journal of Gerontological NursingEFFECT OF CERUMEN ON INFRARED EAR TEMPERATURE MEASUREMENT
20 Citations1995Karen L Hasel, Roberta Erickson
Improved hearing may be a more important outcome of cerumen removal, with secondary benefit for temperature measurement, with secondarily offset by the time and inconvenience of the irrigation procedure.
PubMedComparison of aortic and brachial cuff pressures in flat supine and lateral recumbent positions.
19 Citations1981Newton Km
Down-arm pressure findings were inconsistent, and Influences including hydrostatic effects and flow changes resulting from compression of the brachial artery by the weight of the person's body on the arm may account for this inconsistency.
BMJErrors in using clinical thermometers.
17 Citations1976David Coggon, Martin Vessey
Antinuclear antibodies and the rheumatoid factor in cases of asbestosis probably result from the pulmonary lesions and are not evidence of an autoimmune mechanism in the pathogenesis of the disease.
JAMAThe New Vital Sign
17 Citations1992David E. Conwill
In the experience, many physicians agree with the philosophy of appropriate clinical preventive medicine efforts but neglect to incorporate such efforts into the usual clinical setting, particularly if the patient's chief complaint lies in an area divorced from such efforts.
CHEST JournalIs Routine Assessment of Arterial Oxygen Saturation In Pulmonary Outpatients Indicated?
16 Citations1988M. Loggan, Gerald R. Kerby +1 more
Routine pulse oximetry does not appear to be of value in screening large numbers of pulmonary outpatients for unexpected desaturation, since it is uncommon in the absence of associated clinical findings.
Contemporary NurseThe routine of post anaesthetic observations
16 Citations1994Mari Botti, Jennifer O. Hunt
Australian and New Zealand Journal of Obstetrics and GynaecologyErrors in the Measurement of Blood Pressure
13 Citations1983Susan Fleming, John S. Horvath +1 more
In non‐pregnant patients undergoing cardiac catheterization, central blood pressure remained unaltered with a change from the supine to the lateral position, however in all subjects studied, an apparent decrease in both systolic and diastolic blood pressure occurred when measured in the upper arm in the lateral positions.
College student journalMonitoring vital signs to identify postoperative complications.
12 Citations1995Susan Schumacher
An evaluation study was conducted to determine the effects of changing the frequency of vital signs on recognizing complications and the results supported reducing the frequencyof vital signs monitoring.
PubMedEffects of bell versus diaphragm on indirect blood pressure measurement.
11 Citations1988A. Mauro
The purpose of this study was to determine the effects of using the bell versus the diaphragm of the stethoscope on indirect blood pressure (BP) measurement and three research hypotheses were tested.
Nursing ResearchThree-Minute Time Interval when Using an Oral Mercury-in-Glass Thermometer with or Without J-Temp Sheaths
11 Citations1980Ruby D. Graves, Martha F. Markarlan
PubMedAre four duplicate remeasurements sufficient for diagnosing mild hypertension?
5 Citations1996M Brueren, H. Petri +3 more
The numbers of two, three or four BP measurements recommended by international guidelines for diagnosing hypertension are too low, and a considerable amount of misclassification remains after four duplicate remeasurements.
Nursing ResearchTime Analyses of Afebrile and Febrile Temperature Readings
4 Citations1972Glannadee A. Nichols
There were considerable differences in the individual times for measuring oral readings, but less variation was present for rectal readings.