3217 Triage measurements in the emergency department overestimate blood pressure

Aims and Objectives Patients who present to the Emergency Department (ED) usually have their blood pressure (BP) measured as part of their routine triage assessment. BP measurements suggesting hypertension (≥140 systolic or ≥90 diastolic) are a frequent incidental finding, unrelated to the patient’s presenting complaint, but require follow-up. Hypertension is associated with an increased risk of cardiovascular events, so its detection in ED may be an opportunity to initiate further investigations and management. Method and Design A service evaluation was undertaken between 01/09/2023 and 31/10/2023 to compare triage BP measurements taken in the Sheffield Northern General Hospital ED with readings taken according to NICE guidance. Ambulatory patients attending the ED who had received BP measurement as part of their initial triage assessment were selected using convenience sampling, with three BP measurements undertaken using an appropriate cuff size, recorded, and compared to their triage BP readings. Results and Conclusion A total of 102 patients were included in the final analysis. The mean triage BP was 144/88 mmHg and the mean standardised BP was 131/83 mmHg. The mean difference between systolic and diastolic readings was 13.4 (95% CI 10.07 – 16.76) and 4.6 (95% CI 1.99 – 7.13) mmHg respectively (both p<0.001 on student t-test). Using the defined parameters of stage one hypertension, 59 patients (58%) had triage measurements suggesting hypertension, with this falling to 42 patients (41%) when performed using standardised methods. 27 patients (26%) who were hypertensive on their standardised measurement had no history of hypertension. These findings indicate that triage BP readings over-estimate blood pressure. Despite this, a substantial proportion of patients with BP ≥140/90 on standardised measurement were demonstrated and may benefit from referral to primary care. Triage BP measurement should be verified by standardised measurement and those with BP ≥140/90 advised to seek follow-up, although this may be difficult to deliver in a crowded emergency department.