TY - JOUR
T1 - Accuracy and interobserver-agreement of respiratory rate measurements by healthcare professionals, and its effect on the outcomes of clinical prediction/diagnostic rules
AU - Latten, Gideon H P
AU - Spek, Michelle
AU - Muris, Jean W M
AU - Cals, Jochen W L
AU - Stassen, Patricia M
N1 - Publisher Copyright:
© 2019 Latten et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2019/10/3
Y1 - 2019/10/3
N2 - OBJECTIVE: In clinical prediction/diagnostic rules aimed at early detection of critically ill patients, the respiratory rate plays an important role. We investigated the accuracy and interobserver-agreement of respiratory rate measurements by healthcare professionals, and the potential effect of incorrect measurements on the scores of 4 common clinical prediction/diagnostic rules: Systemic Inflammatory Response Syndrome (SIRS) criteria, quick Sepsis-related Organ Failure Assessment (qSOFA), National Early Warning Score (NEWS), and Modified Early Warning Score (MEWS).METHODS: Using an online questionnaire, we showed 5 videos with a healthy volunteer, breathing at a fixed (true) rate (13-28 breaths/minute). Respondents measured the respiratory rate, and categorized it as low, normal, or high. We analysed how accurate the measurements were using descriptive statistics, and calculated interobserver-agreement using the intraclass correlation coefficient (ICC), and agreement between measurements and categorical judgments using Cohen's Kappa. Finally, we analysed how often incorrect measurements led to under/overestimation in the selected clinical rules.RESULTS: In total, 448 healthcare professionals participated. Median measurements were slightly higher (1-3/min) than the true respiratory rate, and 78.2% of measurements were within 4/min of the true rate. ICC was moderate (0.64, 95% CI 0.39-0.94). When comparing the measured respiratory rates with the categorical judgments, 14.5% were inconsistent. Incorrect measurements influenced the 4 rules in 8.8% (SIRS) to 37.1% (NEWS). Both underestimation (4.5-7.1%) and overestimation (3.9-32.2%) occurred.CONCLUSIONS: The accuracy and interobserver-agreement of respiratory rate measurements by healthcare professionals are suboptimal. This leads to both over- and underestimation of scores of four clinical prediction/diagnostic rules. The clinically most important effect could be a delay in diagnosis and treatment of (critically) ill patients.
AB - OBJECTIVE: In clinical prediction/diagnostic rules aimed at early detection of critically ill patients, the respiratory rate plays an important role. We investigated the accuracy and interobserver-agreement of respiratory rate measurements by healthcare professionals, and the potential effect of incorrect measurements on the scores of 4 common clinical prediction/diagnostic rules: Systemic Inflammatory Response Syndrome (SIRS) criteria, quick Sepsis-related Organ Failure Assessment (qSOFA), National Early Warning Score (NEWS), and Modified Early Warning Score (MEWS).METHODS: Using an online questionnaire, we showed 5 videos with a healthy volunteer, breathing at a fixed (true) rate (13-28 breaths/minute). Respondents measured the respiratory rate, and categorized it as low, normal, or high. We analysed how accurate the measurements were using descriptive statistics, and calculated interobserver-agreement using the intraclass correlation coefficient (ICC), and agreement between measurements and categorical judgments using Cohen's Kappa. Finally, we analysed how often incorrect measurements led to under/overestimation in the selected clinical rules.RESULTS: In total, 448 healthcare professionals participated. Median measurements were slightly higher (1-3/min) than the true respiratory rate, and 78.2% of measurements were within 4/min of the true rate. ICC was moderate (0.64, 95% CI 0.39-0.94). When comparing the measured respiratory rates with the categorical judgments, 14.5% were inconsistent. Incorrect measurements influenced the 4 rules in 8.8% (SIRS) to 37.1% (NEWS). Both underestimation (4.5-7.1%) and overestimation (3.9-32.2%) occurred.CONCLUSIONS: The accuracy and interobserver-agreement of respiratory rate measurements by healthcare professionals are suboptimal. This leads to both over- and underestimation of scores of four clinical prediction/diagnostic rules. The clinically most important effect could be a delay in diagnosis and treatment of (critically) ill patients.
KW - Health Personnel
KW - Humans
KW - Observer Variation
KW - Respiratory Rate/physiology
KW - Surveys and Questionnaires
KW - Video Recording
UR - http://www.scopus.com/inward/record.url?scp=85072830809&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0223155
DO - 10.1371/journal.pone.0223155
M3 - Article
C2 - 31581207
SN - 1932-6203
VL - 14
JO - PLoS ONE
JF - PLoS ONE
IS - 10
M1 - e0223155
ER -