Dynamic threshold algorithm to evaluate trustworthiness of the estimated blood pressure in oscillometry

Blood pressure (BP) readings in oscillometry are very sensitive to the posture of the body, arm, and body movements during the BP measurements, so measuring conditions are the first important factors for trusted BP readings. Next is the BP estimation algorithm, which is responsible to convert the cuff deflation curve (CDC) pressure signal to accurate BP readings. With proper measuring conditions and an accurate BP estimation algorithm one can expect trusted BP readings. Trustworthiness of the BP readings is still a challenging issue in automated oscillometric BP monitors, and patients need to see the doctor for trusted measurements. To this end, we have proposed a novel method called a Dynamic Threshold Algorithm (DTA) that evaluates trustworthiness of the BP readings immediately after the BP is estimated, such that the patient can decide whether to repeat the measurement or not. DTA employs the heart rate (HR) of the subject and determines a specific threshold (TR). TR is used to determine maximum and minimum limits for trustable pressures (SBP2, DBP2) of a given subject. The limits are called trusted boundaries (TB). Trusted boundaries are compared with the estimated systolic blood pressure (SBP) and diastolic blood pressure (DBP) to determine trustworthiness of the measured BP. BP readings are trusted if estimated SBP and DBP are inside the TB and untrusted or labeled an outlier if otherwise. In this research, DTA is applied on three different data- sets of healthy and sick subjects, outliers are determined and removed from the datasets, and remaining recordings are validated against references and compared with validated results of original datasets. According to observations, improvements were significant after outliers were removed from the datasets.

[1]  G. Drzewiecki,et al.  Theory of the oscillometric maximum and the systolic and diastolic detection ratios , 2006, Annals of Biomedical Engineering.

[2]  E. Iso,et al.  Measurement Uncertainty and Probability: Guide to the Expression of Uncertainty in Measurement , 1995 .

[3]  F. Forster,et al.  Oscillometric determination of diastolic, mean and systolic blood pressure--a numerical model. , 1986, Journal of biomechanical engineering.

[4]  E. O’Brien,et al.  The British Hypertension Society protocol for the evaluation of automated and semi-automated blood pressure measuring devices with special reference to ambulatory systems. , 1990, Journal of hypertension.

[5]  John N. Amoore,et al.  Extracting oscillometric pulses from the cuff pressure: does it affect the pressures determined by oscillometric blood pressure monitors? , 2006, Blood pressure monitoring.

[6]  G. Stergiou,et al.  Unreliable oscillometric blood pressure measurement: prevalence, repeatability and characteristics of the phenomenon , 2009, Journal of Human Hypertension.

[7]  A. Ferrero,et al.  Measurement Uncertainty - Part 8 in a series of tutorials in intsrumentation and measurement , 2006 .

[8]  Chin-Teng Lin,et al.  Reduction of interference in oscillometric arterial blood pressure measurement using fuzzy logic , 2003, IEEE Trans. Biomed. Eng..

[9]  Pamela Jo Johnson,et al.  Invasive blood pressure monitoring systems in the ICU: influence of the blood-conserving device on the dynamic response characteristics and agreement with noninvasive measurements , 2012, Blood pressure monitoring.

[10]  Joon-Hyuk Chang,et al.  Oscillometric Blood Pressure Estimation Based on Maximum Amplitude Algorithm Employing Gaussian Mixture Regression , 2013, IEEE Transactions on Instrumentation and Measurement.

[11]  M. Bolic,et al.  Assessment of algorithms for oscillometric blood pressure measurement , 2009, 2009 IEEE Instrumentation and Measurement Technology Conference.

[12]  Mansour Razminia,et al.  Validation of a new formula for mean arterial pressure calculation: The new formula is superior to the standard formula , 2004, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[13]  A Murray,et al.  Effect of respiration, talking and small body movements on blood pressure measurement , 2012, Journal of Human Hypertension.

[14]  Voicu Groza,et al.  Method for evaluation of trustworthiness of oscillometric blood pressure measurements , 2015, 2015 IEEE International Symposium on Medical Measurements and Applications (MeMeA) Proceedings.

[15]  A S Berson,et al.  National Standard for Measurement of Resting and Ambulatory Blood Pressures With Automated Sphygmomanometers , 1993, Hypertension.

[16]  M. Safar,et al.  Blood pressure measurement: retrospective and prospective views. , 2011, American journal of hypertension.

[17]  M. Nitzan,et al.  Automatic noninvasive measurement of arterial blood pressure , 2011, IEEE Instrumentation & Measurement Magazine.

[18]  Daniel J. Sebald,et al.  Narrowband auscultatory blood pressure measurement , 2002, IEEE Transactions on Biomedical Engineering.

[19]  Sc Prospective,et al.  Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies , 2002 .

[20]  Voicu Groza,et al.  Augmented blood pressure measurement through the noninvasive estimation of physiological arterial pressure variability , 2012, Physiological measurement.

[21]  B. Alpert,et al.  Oscillometric blood pressure: a review for clinicians. , 2014, Journal of the American Society of Hypertension : JASH.

[22]  L. Geddes,et al.  Characterization of the oscillometric method for measuring indirect blood pressure , 2006, Annals of Biomedical Engineering.

[23]  Voicu Groza,et al.  Electrocardiogram-Assisted Blood Pressure Estimation , 2012, IEEE Transactions on Biomedical Engineering.

[24]  G WERNER,et al.  The measurement of uncertainty , 1961, Clinical pharmacology and therapeutics.