This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (53) Citing Articles via Google Scholar Google Scholar Articles by Mantha, S. Articles by Foss, J. Search for Related Content PubMed PubMed Citation Articles by Mantha, S. Articles by Foss, J.

---

ECONOMICS AND HEALTH SYSTEMS MANAGEMENT

Comparing Methods of Clinical Measurement: Reporting Standards for Bland and Altman Analysis

Srinivas Mantha, MD^*,, Michael F. Roizen, MD, Lee A. Fleisher, MD, FACC^§, Ronald Thisted, PhD, and Joseph Foss, MD

*Department of Anesthesiology and Intensive Care, Nizam’s Institute of Medical Sciences, Hyderabad, India; Departments of Anesthesia and Critical Care and Statistics and Health Studies, University of Chicago, Chicago, Illinois; and §Department of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, Maryland

Address correspondence and reprint requests to Srinivas Mantha, MD, 13/4 RT, LIGH, Barkatpura, Hyderabad 500027, India. Address e-mail to smantha{at}satyam.net.in

Abstract

In this era of medical technology assessment and evidence-based medicine, evaluating new methods to measure physiologic variables is facilitated by standardization of reporting results. It has been proposed that assessing repeatability be followed by assessing agreement with an established technique. If the "limits of agreement" (mean bias ± 2SD) are not clinically important, then one could use two measurements interchangeably. Generalizability to larger populations is facilitated by reporting confidence intervals. We identified 44 studies that compared methods of clinical measurement published during 1996 to 1998 in seven anesthesia journals. Although 42 of 44 (95.4%) used the limits of agreement methodology for analysis, several inadequacies and inconsistencies in reporting the results were noted. Limits of agreement were defined a priori in 7.1%, repeatability was evaluated in 21.4%, and relationship (pattern) between difference and average was evaluated in 7.1%. Only one of the articles reported confidence intervals. A computer macro for the Minitab statistical package (State College, PA) is described to facilitate reporting of Bland and Altman analysis with confidence intervals. We propose standardization of nomenclature in clinical measurement comparison studies.

Implications: A literature review of anesthesia journals revealed several inadequacies and inconsistencies in statistical reports of results of comparison studies with regard to interchangeability of measurement methods. We encourage journal editors to evaluate submissions on this subject carefully to ensure that their readers can draw valid conclusions about the value of new technologies.

This article has been cited by other articles:

				A. Faisal, K. R. Beavers, A. D. Robertson, and R. L. Hughson Prior moderate and heavy exercise accelerate oxygen uptake and cardiac output kinetics in endurance athletes J Appl Physiol, May 1, 2009; 106(5): 1553 - 1563. [Abstract] [Full Text] [PDF]

				D. M. Takanishi, M. Yu, F. Lurie, E. Biuk-Aghai, H. Yamauchi, H. C. Ho, and A. D. Chapital Peripheral Blood Hematocrit in Critically Ill Surgical Patients: An Imprecise Surrogate of True Red Blood Cell Volume Anesth. Analg., June 1, 2008; 106(6): 1808 - 1812. [Abstract] [Full Text] [PDF]

				S. Hwan Kim, K. Hun Lee, K. Bong Yoon, W. Young Park, and D.-M. Yoon Sonographic Estimation of Needle Depth for Cervical Epidural Blocks Anesth. Analg., May 1, 2008; 106(5): 1542 - 1547. [Abstract] [Full Text] [PDF]

				P. S. Halvorsen, A. Sokolov, M. Cvancarova, P. K. Hol, R. Lundblad, and T. I. Tonnessen Continuous cardiac output during off-pump coronary artery bypass surgery: pulse-contour analyses vs pulmonary artery thermodilution Br. J. Anaesth., October 1, 2007; 99(4): 484 - 492. [Abstract] [Full Text] [PDF]

				R. E. Anderson, U. Sartipy, and J. G. Jakobsson Use of conventional ECG electrodes for depth of anaesthesia monitoring using the cerebral state index: a clinical study in day surgery Br. J. Anaesth., May 1, 2007; 98(5): 645 - 648. [Abstract] [Full Text] [PDF]

				S. Boodhan, A. M. Maloney, and L. L. Dupuis Extent of Agreement in Gentamicin Concentration Between Serum That Is Drawn Peripherally and From Central Venous Catheters Pediatrics, December 1, 2006; 118(6): e1650 - e1656. [Abstract] [Full Text] [PDF]

				L. A. Critchley, Z. Y. Peng, B. S. Fok, A. Lee, and R. A. Phillips Testing the Reliability of a New Ultrasonic Cardiac Output Monitor, the USCOM, by Using Aortic Flowprobes in Anesthetized Dogs Anesth. Analg., March 1, 2005; 100(3): 748 - 753. [Abstract] [Full Text] [PDF]

				J. S. Jahr, S. Osgood, S. J. Rothenberg, Q.-L. Li, A. W. Butch, R. Gunther, A. Cheung, and B. Driessen Lactate Measurement Interference by Hemoglobin-Based Oxygen Carriers (Oxyglobin(R), Hemopure(R), and HemolinkTM) Anesth. Analg., February 1, 2005; 100(2): 431 - 436. [Abstract] [Full Text] [PDF]

				S. L. Osgood, J. S. Jahr, P. Desai, J. Tsukamoto, and B. Driessen Does Methemoglobin from Oxidized Hemoglobin-Based Oxygen Carrier (Hemoglobin Glutamer-200) Interfere with Lactate Measurement (YSI 2700 SELECTTM Biochemistry Analyzer)? Anesth. Analg., February 1, 2005; 100(2): 437 - 439. [Abstract] [Full Text] [PDF]

				D. Stockl, D. Rodriguez Cabaleiro, K. Van Uytfanghe, and L. M. Thienpont Interpreting Method Comparison Studies by Use of the Bland-Altman Plot: Reflecting the Importance of Sample Size by Incorporating Confidence Limits and Predefined Error Limits in the Graphic Clin. Chem., November 1, 2004; 50(11): 2216 - 2218. [Full Text] [PDF]

				J. A. Victorino, J. B. Borges, V. N. Okamoto, G. F. J. Matos, M. R. Tucci, M. P. R. Caramez, H. Tanaka, F. S. Sipmann, D. C. B. Santos, C. S. V. Barbas, et al. Imbalances in Regional Lung Ventilation: A Validation Study on Electrical Impedance Tomography Am. J. Respir. Crit. Care Med., April 1, 2004; 169(7): 791 - 800. [Abstract] [Full Text] [PDF]

				N. L. Szaflarski "Physicians' estimates of cardiac index and intravascular volume based on clinical assessment versus transesophageal Doppler measurements obtained by critical care nurses". Am. J. Crit. Care., March 1, 2004; 13(2): 100 - 101. [Full Text] [PDF]

				N. L. Szaflarski, P. Potter, M. Schallom, S. Davis, C. Sona, and M. McSweeney "Evaluation of chemical dot thermometers in orally intubated patients". Am. J. Crit. Care., March 1, 2004; 13(2): 169 - 170. [Full Text] [PDF]

				M. Ganter and A. Zollinger Continuous intravascular blood gas monitoring: development, current techniques, and clinical use of a commercial device Br. J. Anaesth., September 1, 2003; 91(3): 397 - 407. [Abstract] [Full Text] [PDF]

				R. Serianni, J. Barash, T. Bentley, P. Sharma, J. L. Fontana, D. Via, J. Duhm, R. Bunger, and P. D. Mongan Porcine-specific hemoglobin saturation measurements J Appl Physiol, February 1, 2003; 94(2): 561 - 566. [Abstract] [Full Text] [PDF]

				A. M.-H. Ho, A. Lee, E. Ling, A. Daly, K. Teoh, and T. E. Warkentin Agreements Between the Prothrombin Times of Blood Treated In Vitro with Heparinase During Cardiopulmonary Bypass (CPB) and Blood Sampled After CPB and Systemic Protamine Anesth. Analg., January 1, 2003; 96(1): 15 - 20. [Abstract] [Full Text] [PDF]

				F. Lurie, J. S. Jahr, and B. Driessen The Novel HemoCue(R) Plasma/Low Hemoglobin System Accurately Measures Small Concentrations of Three Different Hemoglobin-Based Oxygen Carriers in Plasma: Hemoglobin Glutamer-200 (Bovine) (Oxyglobin(R)), Hemoglobin Glutamer-250 (Bovine) (Hemopure(R)), and Hemoglobin-Raffimer (HemolinkTM) Anesth. Analg., October 1, 2002; 95(4): 870 - 873. [Abstract] [Full Text] [PDF]

				K. Dewitte, C. Fierens, D. Stockl, and L. M. Thienpont Application of the Bland-Altman Plot for Interpretation of Method-Comparison Studies: A Critical Investigation of Its Practice Clin. Chem., May 1, 2002; 48(5): 799 - 801. [Full Text] [PDF]

				C. K. Hofer, M. Ganter, M. Tucci, R. Klaghofer, and A. Zollinger How reliable is length-based determination of body weight and tracheal tube size in the paediatric age group? The Broselow tape reconsidered Br. J. Anaesth., February 1, 2002; 88(2): 283 - 285. [Abstract] [Full Text] [PDF]

				A. A. Awad, M. A. M. Ghobashy, R. G. Stout, D. G. Silverman, and K. H. Shelley How Does the Plethysmogram Derived from the Pulse Oximeter Relate to Arterial Blood Pressure in Coronary Artery Bypass Graft Patients? Anesth. Analg., December 1, 2001; 93(6): 1466 - 1471. [Abstract] [Full Text] [PDF]