Background: counting respiratory rate over 60 seconds can be impractical in a busy clinical setting.

Methods: 870 respiratory rates of 272 acutely ill medical patients estimated from observations over 15 seconds and those calculated by a computer algorithm were compared.

Results: The bias of 15 seconds of observations was 1.85 breaths per minute and 0.11 breaths per minute for the algorithm derived rate, which took 16.2 SD 8.1 seconds. The algorithm assigned 88% of respiratory rates their correct National Early Warning Score points, compared with 80% for rates from 15 seconds of observation.

Conclusion: The respiratory rates of acutely ill patients are measured nearly as quickly and more reliably by a computer algorithm than by observations over 15 seconds.

[download-attachments container="div" style="list" display_icon="1" display_count="1" display__size="0"]

References

1. Strauß R, Ewig S, Richter K, König T, Heller G, Bauer T. The prognostic significance of respiratory rate in patients with pneumonia: a retrospective analysis of data from 705 928 hospitalized patients in Germany from 2010–2012. Deutsches ßrzteblatt International 2014;111:503–8
2. Badawy J , Nguyen OK, Clark C, Halm EA, Makam AN.Is everyone really breathing 20 times a minute? Assessing epidemiology and variation in recorded respiratory rate in hospitalised adults. BMJ Qual Saf. 2017;26:832–836 .
3. Semler MW , Stover DG, Copland AP, Hong G, Johnson MJ, Kriss MS. et al. Flash mob research: a single-day, mul-ticenter, resident-directed study of respiratory rate. Chest. 2013;143:1740–1744 .
4. Hooker EA, O’Brien DJ, Danzl DF, Barefoot JA, Brown JE. Respiratory rates in emergency department patients. The Journal of emergency medicine 1989;7:129-132.
5. Bianchi W, Dugas AF, Hsieh YH, Saheed M, Hill P, Lindauer C, Rothman RE. Revitalizing a vital sign: improving detection of tachypnea at primary triage. Annals of emergency medicine 2013;61:37-43.
6. Karlen W, Gan H, Chiu M, Dunsmuir D, Zhou G, Dumont GA, et al. Improving the Accuracy and Efficiency of Respiratory Rate Measurements in Children Using Mobile Devices. PLoS ONE 2014; 9(6): e99266. doi:10.1371/journal.pone.0099266
7. Gan H, Karlen W, Dunsmuir D, Zhou G, Chiu M, Dumont GA, Ansermino JM. The Performance of a Mobile Phone Respiratory Rate Counter Compared to the WHO ARI Timer. Journal of Healthcare Engineering 2015;6(4):691-704.
8. RRate on iTunes AppStore website. Available: https://itunes.apple.com/ca/app/rrate/id581390517. Accessed 2019 Jan 14.
9. RRate on Google Play website. Available: https://play.google.com/store/apps/details?id=ca.bccw.rrate. Accessed 2019 Jan 14.
10. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet.1986;1(8476):307-310.
11. Hamilton C, Stamey J. Using Bland-Altman to assess agreement between two medical devices – don’t for the confidence intervals! Journal of Clinical Monitoring and Computing 2007;21:331–333
12. Royal College of Physicians (RCP). National Early Warning Score (NEWS): Standardising the Assessment of Acute Illness Severity in the NHS. Report of a Working Party. London: RCP; 2012.
13. World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 2013; 310:2191–4.
14. Vandenbroucke JP, von Elm E, Altman DG, Gotzsche PC, Mulrow CD, Pocock SJ. et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Epidemiology. 2007;18:805-835.
15. Hill A, Kelly E, Horswill MS, Watson MO. The effects of awareness and count duration on adult respiratory rate measurements: An experimental study. J Clin Nurs. 2018;27:546–554.
16. Rimbi M, Dunsmuir D, Ansermino JM, Nakitende I, Namujwiga T, and Kellett J, on behalf of the Kitovu Hospital Study Group. Respiratory rates observed over 15 and 30 s compared with rates measured over 60 s: practice-based evidence from an observational study of acutely ill adult medical patients during hospital admission. QJM. 2019;112(7):513-517.
17. Buchman TG, Stein PK, Goldstein B. Heart rate variability in critical illness and critical care. Curr Opin Crit Care. 2002;4:311-5.
18. Hermann DM, Siccoli M, Kirov P, Gugger M, Bassetti CL. Central Periodic Breathing During Sleep in Acute Ischemic Stroke. Stroke 2007;38:1082-1084
19. McGee S. Cheyne-Stokes Breathing and Reduced Ejection Fraction. American Journal of Medicine 2013;126:536-540
20. Achermann S, Caspar M, Wirth C, Becker C, Rocque M, Kirenko I, Schlack A, Dutilh G, Bingisser R, Nickel CH. Contact-free monitoring of respiratory rates for triage of patients presenting to the emergency department. Resuscitation 2019;137:154-155.
21. Subbe CP, Kinsella S. Continuous Monitoring of Respiratory Rate in Emergency Admissions: Evaluation of the RespiraSense™ Sensor in Acute Care Compared to the Industry Standard and Gold Standard. Sensors 2018, 18, 2700; doi:10.3390/s18082700