EVERGREEN

Joint Journal of Novel Carbon Resource Sciences and Green Asia Strategy

ISSN:2189-0420 (Print until Mar 2020)
ISSN:2432-5953 (Online)

SCImago Journal & Country Rank

Open Access
Scopus
Google Scholar
Crossref
SCImago Journal & Country Rank
4.3
2024CiteScore
 
69th percentile
Powered by Scopus
Metrics by SCOPUS 2024
CiteScore
4.3
SJR
0.391
SNIP
1.192

Comparative Performance of High-End and Economical Stethoscopes in Automated Auscultation

Nurdina Gita Pratiwi1,*, Debora Aprilia Br Bangun2, Rudi Setiawan2, Asep Rahmat Hidayat1, Wuwus Adriatna1, Siddiq Wahyu Hidayat1, Novitasari1, Asep Insani1, Yasmin1, Suherlan1
1Research Center for Equipment Manufacturing Technology, National Research and Innovation Agency (BRIN), Indonesia
2Biomedical Engineering, Sumatera Institute of Technology, Indonesia
*Author to whom correspondence should be addressed:
E-mail: nurdina.gita.pratiwi@brin.go.id (NGP)
Evergreen, Vol. 13, Iss. 01, pp. 45–56, 2026
DOI: 10.5109/7405127
Creative Commons Attribution 4.0 International Creative Commons Attribution 4.0 International
Received: May 27, 2025 | Revised: July 04, 2025 | Accepted: December 22, 2025 | Published: March 2026
Abstract
Blood pressure measurement is a vital procedure in assessing cardiovascular health. Automated auscultation is being developed to detect Korotkoff sounds that determine systolic and diastolic blood pressure. The quality of the stethoscopes influences the accuracy of this development. This study aims to evaluate and compare the performance of a high-end (Littmann) and an economical (ABN) stethoscope in detecting Korotkoff sounds for blood pressure measurements using the automatic auscultation method. The study used a mixed design, combining between-subject and within-subject approaches. This comparative experimental study involved 85 respondents with three repetitions of measurements, resulting in a total of 255 data for each stethoscope. The suitability of the measurements was evaluated based on the international accuracy standards AAMI/ANSI/ISO and BHS and analyzed using non-parametric statistical test. The results showed that ABN had an average systolic measurement error of 4.4 ± 4.8 mmHg with a percentage of agreement of 75%, 91%, and 95% at thresholds 5, 10, and 15 mmHg. Meanwhile, Littmann showed a lower average systolic error of 3.4 ± 3.5 mmHg with an agreement of 80%, 96%, and 98%. For diastolic measurements, both stethoscopes showed similar mean errors of 4.1 ± 4.1 mmHg. Paired analysis revealed a significant difference in manual systolic pressure, while diastolic measurements showed no significant difference between ABN and Littmann. Overall, although both stethoscopes met the established accuracy standards, Littmann was superior in consistency and accuracy of systolic measurements, which are important in evaluating Korotkoff sounds in blood pressure measurements using automatic auscultation. However, ABN can still be considered a reliable alternative, particularly for diastolic pressure measurement.
Keywords
automatic auscultation; blood pressure measurement; Korotkoff sound; stethoscope
Available Repositories
Journal DOI Zenodo Archive
Share Article
Article Metrics
--
Views
--
Downloads
--
Citations
Export Citation
BibTeX RIS Semantic Scholar CrossRef Mendeley Google Scholar
Full Text
Download PDF
References
  1. 1) ResultsRespondent data evaluation
  2. 2) Comparison of Stethoscopes Performance for Automated Auscultation
  3. 3) F.D. Fuchs, and P.K. Whelton, "High blood pressure and cardiovascular disease," Hypertension, 75 (2) 285-292 (2020) doi:10.1161/HYPERTENSIONAHA.119.14240
  4. 4) B. Zhou, P. Perel, G.A. Mensah, and M. Ezzati, "Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension," Nat. Rev. Cardiol., 18 (11) 785-802 (2021) doi:10.1038/s41569-021-00559-8
  5. 5) Y. Turana, J. Tengkawan, and A.A. Soenarta, "Asian management of hypertension: current status, home blood pressure, and specific concerns in indonesia," J. Clin. Hypertens., 22 (3) 483-485 (2020) doi:10.1111/jch.13681
  6. 6) F.R. Shuvo, F.F. Haque, and K.M.A. Kabir, "Modeling the impact of combined effect of vaccination, testing, and treatment on epidemic dynamics," Evergreen, 11 (3) 1498-1507 (2024) doi:10.5109/7236807
  7. 7) S.A. Noh, H.S. Kim, S.H. Kang, C.H. Yoon, T.J. Youn, and I.H. Chae, "History and evolution of blood pressure measurement," Clin. Hypertens., 30 (1) 1-13 (2024) doi:10.1186/s40885-024-00268-7
  8. 8) E. Verrif, C. van Montfrans, and J.W. Bos, "Reintroduction of riva-rocci measurements to determine systolic blood pressure?," Neth. J. Med., 66 (11) 480-482 (2008). doi:https://pubmed.ncbi.nlm.nih.gov/19075314/
  9. 9) C.E. Grim, and C.M. Grim, "Auscultatory bp: still the gold standard," J. Am. Soc. Hypertens., 10 (3) 191-193 (2016) doi:10.1016/j.jash.2016.01.004
  10. 10) P. Muntner, D. Shimbo, R.M. Carey, J.B. Charleston, T. Gaillard, S. Misra, M.G. Myers, G. Ogedegbe, J.E. Schwartz, R.R. Townsend, E.M. Urbina, A.J. Viera, W.B. White, and J.T. Wright, "Measurement of blood pressure in humans: a scientific statement from the american heart association," Hypertension, 73 (5) E35–E66 (2019) doi:10.1161/HYP.0000000000000087
  11. 11) R. Kumar, P.K. Dubey, A. Zafer, A. Kumar, and S. Yadav, "Past, present and future of blood pressure measuring instruments and their calibration," Meas. J. Int. Meas. Confed., 172 108845 (2021) doi:10.1016/j.measurement.2020.108845
  12. 12) J. Baranger, O. Villemain, G. Goudot, A. Dizeux, H. Le Blay, T. Mirault, E. Messas, M. Pernot, and M. Tanter, "The fundamental mechanisms of the korotkoff sounds generation," Sci. Adv., 9 (40) (2023) doi:10.1126/sciadv.adi4252
  13. 13) C.F. Babbs, "The origin of korotkoff sounds and the accuracy of auscultatory blood pressure measurements the origin of korotkoff sounds and the accuracy of auscultatory blood pressure measurements," J. Am. Soc. Hypertens., (2015) doi:10.1016/j.jash.2015.09.011
  14. 14) P. Fan, H. Peiyu, C. Fei, P. Xiaobo, Z. Qijun, and Z. Dingchang, "Deep learning based automatic blood pressure measurement: evaluation of the effect of deep breathing, talking and arm movement," Ann. Med., 0 (0) 000 (2019) doi:10.1080/07853890.2019.1694170
  15. 15) N.G. Pratiwi, A.W. Setiawan, D. Naufal, and L. Lindayani, "A review of equipment and signal processing of the automated auscultation for blood pressure measurement," ISMEE 2021 - 2021 3rd Int. Symp. Mater. Electr. Eng. Conf. Enhancing Res. Qual. F. Mater. Electr. Eng. a Better Life, 26-31 (2021) doi:10.1109/ISMEE54273.2021.9774036
  16. 16) J. O’Sullivan, J. Allen, and A. Murray, "The forgotten korotkoff phases: how often are phases ii and iii present, and how do they relate to the other korotkoff phases," Am. J. Hypertens., 15 (3) 264-268 (2002) doi:10.1016/S0895-7061(01)02276-2
  17. 17) J. Allen, T. Gehrke, J.J.O. Sullivan, S.T. King, and A. Murray, "Characterization of the korotkoff sounds using joint time – frequency analysis," Physiol. Meas., 107 (2004) doi:10.1088/0967-3334/25/1/010
  18. 18) M.N. Hamidon, and A. Al-zaben, "The characteristics of korotkoff sounds using the instantaneous frequency method," Int. Conf. Signal Process., (January) (2014). doi:https://dl.acm.org/doi/10.5555/1347816.1347819
  19. 19) J. Lee, Y. Chee, I. Kim, N. Karpettas, A. Kollias, N. Atkins, G.S. Stergiou, and E.O. Brien, "High-fidelity digital recording and playback sphygmomanometry system : device description and proof of concept," Blood Press. Monit., 266-272 (2015) doi:10.1097/MBP.0000000000000109
  20. 20) Y. Wang, J. She, H. Xiang, Y. Li, J. Liu, D. Li, and M. Yu, "Improving auscultatory blood pressure measurement with electronic and computer technology : the visual auscultation method," Nature, 22 (6) 624-629 (2009) doi:10.1038/ajh.2009.30
  21. 21) T.R. Macaulay, D.N. Erceg, B. McMillan, J.E. Ramirez, J.F. Dominguez, A.F. Vallejo, and E. Todd Schroeder, "Validation of an automated and adjustable blood pressure system for use with a public health station," Vasc. Health Risk Manag., 16 133-142 (2020) doi:10.2147/VHRM.S246401
  22. 22) A. Menti, A. Ntineri, K.G. Kyriakoulis, A. Theodosiadi, V. Ntousopoulos, P. Stathopoulou, A. Kollias, and G.S. Stergiou, "Visual assessment of korotkoff sounds improves the accuracy of a validated professional automated auscultatory blood pressure monitor korot p3 accurate," J. Hypertens., 10-1097 (2024) doi:10.1097/HJH.0000000000003753
  23. 23) C. Fania, A. Giletto, A. Niero, & P. Palatini, Accuracy of the KOROT P3 Accurate automated auscultatory blood pressure measuring device for professional use in people with extra-large arms," Blood Pressure Monitoring, 29 (3), 144-148 (2024) doi:10.1097/MBP.0000000000000696
  24. 24) A. Ntineri, A. Theodosiadi, A. Menti, K.G. Kyriakoulis, V. Ntousopoulos, A. Kollias, and G.S. Stergiou, "A novel professional automated auscultatory blood pressure monitor with visual display of korotkoff sounds: inbody bpbio480kv validation according to the association for the advancement of medical instrumentation/european society of hypertension/internati," J. Hypertens., 41 (2) 356-361 (2023) doi:10.1097/HJH.0000000000003341
  25. 25) N.G. Pratiwi, A.W. Setiawan, D. Naufal, and L. Lindayani, "The design of korotkoff sound detection using amplitude parameter and oscillation beat to estimate non-invasive blood pressure," 2023 Int. Semin. Intell. Technol. Its Appl. Leveraging Intell. Syst. to Achieve Sustain. Dev. Goals, ISITIA 2023 - Proceeding, 587-592 (2023) doi:10.1109/ISITIA59021.2023.10221160
  26. 26) D. Naufal, "Blood pressure measuring device based on korotkoff sound ’ s tapping period and frequency detection," Int. Semin. Intell. Technol. Its Appl. Humanification Reliab. Intell. Syst. ISITIA, 158-163 (2020) doi:10.1109/ISITIA49792.2020.9163700
  27. 27) D. Naufal, and M.Y. Khalil, "Automated auscultatory blood pressure measurements using korotkoff sounds detection : a preliminary study," Int. Conf. Instrumentation, Control. Autom. ICA, (August) 71-76 (2019) doi:10.1109/ICA.2019.8916727
  28. 28) F. Pan, P. He, F. Chen, J. Zhang, H. Wang, and D. Zheng, "A novel deep learning based automatic auscultatory method to measure blood pressure," Int. J. Med. Inform., 1-22 (n.d.) doi:10.1016/j.ijmedinf.2019.04.023
  29. 29) F. Pan, P. He, C. Liu, T. Li, A. Murray, and D. Zheng, "Variation of the korotkoff stethoscope sounds during blood pressure measurement: analysis using a convolutional neural network," IEEE J. Biomed. Heal. Informatics, 21 (6) 1593-1598 (2017) doi:10.1109/JBHI.2017.2703115
  30. 30) F. Pan, P. He, H. Wang, Y. Xu, X. Pu, Q. Zhao, F. Chen, and D. Zheng, "Biomedical signal processing and control development and validation of a deep learning-based automatic auscultatory blood pressure measurement method," Biomed. Signal Process. Control, 68 (February) 102742 (2021) doi:10.1016/j.bspc.2021.102742
  31. 31) C. Goh, and S. Nakatake, "A sensor-based data visualization system for training blood pressure measurement by auscultatory method," IEICE Trans. Inf. Syst., (4) 936-943 (2016) doi:10.1587/transinf.2015DAP0010
  32. 32) A. Regueiro-Gómez, R. Pallas-Areny, and R. Pallás-Areny, "A new method for automated blood pressure measurement," Iopscience.Iop.Org, 19 205-212 (1998) doi:10.1088/0967-3334/19/2/008
  33. 33) G. Saggio, M. Tiberti, A. Leggieri, G. Amicucci, M. Maola, and M. Mazzotta, "A novel automatic method to determine blood pressure based on thresholds of audibility," Br. J. Appl. Sci. Technol., 7 (4) 364-371 (2015) doi:10.9734/BJAST/2015/14310
  34. 34) W. Chen, F. Chen, Y. Feng, A. Chen, and Di. Zheng, "Quantitative assessment of blood pressure measurement accuracy and variability from visual auscultation method by observers without receiving medical training," Biomed Res. Int., (2017) doi:10.1155/2017/3537079
  35. 35) M. Wolff, U. Kordon, H. Hussein, M. Eichner, R. Hoffmann, and C. Tschnpe, "AUSCULTATORY blood pressure measurement using hmms," ICASSP, IEEE Int. Conf. Acoust. Speech Signal Process., 405-408 (2007) doi:10.1109/ICASSP.2007.366702
  36. 36) H. Wu, B. Wang, X. Zhu, G. Chu, and Z. Zhang, "A new automatic blood pressure kit auscultates for accurate reading with a smartphone," Medicine (Baltimore)., (2016) doi:10.1097/MD.0000000000004538
  37. 37) B.G. Celler, P.N. Le, A. Argha, and E. Ambikairajah, "GMM-hmm-based blood pressure estimation using time-domain features," IEEE Trans. Instrum. Meas., 69 (6) 3631-3641 (2020) doi:10.1109/TIM.2019.2937074
  38. 38) J.A. Sukor, "Signal quality measures for unsupervised blood," Physiol. Meas., 465 (2012) doi:10.1088/0967-3334/33/3/465
  39. 39) S.J. Hong, J.S. Lee, J.H. Oh, Y.J. Chee, D.P. Jang, and I.Y. Kim, "Automatic assessment of blood pressure for korotkoff sounds on the basis of human hearing threshold," Blood Press. Monit., (2017) doi:10.1097/MBP.0000000000000284
  40. 40) X. Li, and J.J. Im, "Development of an automatic blood pressure device based on korotkoff sounds," Int. J. Adv. Smart Converg., 8 (2) 227-236 (2019) doi:10.7236/IJASC.2019.8.2.227
  41. 41) X. Li, G. V Panicker, and J.J. Im, "A study for the development of k-sound based automatic blood pressure device using pvdf film," Eng. Med. Biol. Soc., 255-258 (2016) doi:10.1109/EMBC.2016.7590688
  42. 42) D.K. Park, H.S. Oh, J.H. Kang, I.Y. Kim, Y.J. Chee, and J.S. Lee, "Novel method of automatic auscultation for blood pressure measurement using pulses in cuff pressure and korotkoff sound," Comput. Cardiol., 181-184 (2008) doi:10.1109/CIC.2008.4749007
  43. 43) D.J. Sebald, D.E. Bahr, S. Member, A.R. Kahn, and L. Fellow, "Narrowband auscultatory blood pressure measurement daniel," IEEE Trans. Biomed. Eng., 49 (9) 1038-1044 (2002) doi:10.1109/TBME.2002.802056
  44. 44) Grand View Search, "Stethoscope market size, share & trends analysis report by technology type (electronic/digital stethoscope, smart stethoscope), by sales channel, by end-use, by region, and segment forecasts, 2024 - 2030," 1-11 (2024). https://www.grandviewresearch.com/industry-analysis/stethoscopes-market# (accessed June 25, 2025)
  45. 45) D. Weiss, C. Erie, J. Butera, R. Copt, G. Yeaw, M. Harpster, J. Hughes, and D.N. Salem, "An in vitro acoustic analysis and comparison of popular stethoscopes," Med. Devices Evid. Res., 12 41-52 (2019) doi:10.2147/MDER.S186076
  46. 46) LKPP, "Stetoskop littmann classic iii," (n.d.). https://katalog.inaproc.id/bintang-putra-medika/stetoskop-littmann (accessed June 25, 2025)
  47. 47) LKPP, "STETOSKOP majestic abn," (n.d.). https://katalog.inaproc.id/bergas-waras-indonesia/stetoskop-majestic-abn (accessed June 25, 2025)
  48. 48) E.O. Brien, B. Waeber, G. Parati, J. Staessen, and M.G. Myers, "Clinical review blood pressure measuring devices : recommendations of the european society of hypertension," BMJ, 531-536 (2001) doi:10.1136/bmj.322.7285.531
  49. 49) P. Gupta, B. Singh, and Y. Shrivastava, "Robust techniques for signal processing: a comparative study," Evergreen, 9 (2) 404-411 (2022) doi:10.5109/4794165
  50. 50) J. Karnadi, A. Riantono, I. Roihan, and R.A. Koestoer, "Skin and body temperature parameter calibration of max30100 sensor module based on arduino-uno," Evergreen, 11 (2) 1419-1425 (2024) doi:10.5109/7183458
  51. 51) D. GK, Sreerama Samartha JG, and V. M, "AI-enabled automatic attendance monitoring systems," Evergreen, 11 (2) 913-926 (2024) doi:10.5109/7183374
  52. 52) I.R. Kurnianto, A.G. Setiawan, A. Surjosatyo, H. Dafiqurrohman, and R. Dhelika, "Design and implementation of a real-time monitoring system based on internet of things in a 10-kw downdraft gasifier," Evergreen, 9 (1) 145-149 (2022) doi:10.5109/4774230
  53. 53) A.R. Mishra, and A. Baranwal, "Real-time image and video stitching via seamless integration of live camera feeds for enhanced visual quality," Evergreen, 10 (4) 2379-2389 (2023) doi:10.5109/7160928
  54. 54) N. Dhengre, N.S. Rajput, V. Patel, and R. Katarne, "A perspective of the computer mouse’s impact on the musculoskeletal system," Evergreen, 11 (3) 1940-1955 (2024) doi:10.5109/7236843
  55. 55) R. Rani, K.K. Yogi, and S.P. Yadav, "Subjective evaluation of clone attack detection using machine learning approach," Evergreen, 11 (3) 2011-2021 (2024) doi:10.5109/7236848
Other Papers in This Issue