Accuracy and interobserver-agreement of respiratory rate measurements by healthcare professionals, and its effect on the outcomes of clinical prediction/diagnostic rules


Autoři: Gideon H. P. Latten aff001;  Michelle Spek aff003;  Jean W. M. Muris aff002;  Jochen W. L. Cals aff002;  Patricia M. Stassen aff003
Působiště autorů: Emergency Department, Zuyderland Medical Centre, Heerlen, The Netherlands aff001;  Department of Family Medicine, Maastricht University, Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands aff002;  Department of Internal Medicine, division general medicine, section acute medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands aff003
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223155

Souhrn

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.

Klíčová slova:

Blood pressure – Breathing – Heart rate – Nurses – Professions – Questionnaires – Respiration – Systemic inflammatory response syndrome


Zdroje

1. Fieselmann JF, Hendryx MS, Helms CM, Wakefield DS. Respiratory rate predicts cardiopulmonary arrest for internal medicine inpatients. J Gen Intern Med. 1993;8: 354–360. doi: 10.1007/bf02600071 8410395

2. Subbe CP, Davies RG, Williams E, Rutherford P, Gemmell L. Effect of introducing the Modified Early Warning score on clinical outcomes, cardio-pulmonary arrests and intensive care utilisation in acute medical admissions. Anaesthesia. 2003;58: 797–802. doi: 10.1046/j.1365-2044.2003.03258.x 12859475

3. Peltan ID, Brown SM, Bledsoe JR, Sorensen J, Samore MH, Allen TL, et al. ED Door-to-Antibiotic Time and Long-term Mortality in Sepsis. Chest. 2019;155: 938–946. doi: 10.1016/j.chest.2019.02.008 30779916

4. Ferrer R, Martin-Loeches I, Phillips G, Osborn TM, Townsend S, Dellinger RP, et al. Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline-based performance improvement program. Crit Care Med. 2014;42: 1749–1755. doi: 10.1097/CCM.0000000000000330 24717459

5. Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34: 1589–1596. doi: 10.1097/01.CCM.0000217961.75225.E9 16625125

6. Smith GB, Prytherch DR, Meredith P, Schmidt PE, Featherstone PI. The ability of the National Early Warning Score (NEWS) to discriminate patients at risk of early cardiac arrest, unanticipated intensive care unit admission, and death. Resuscitation. 2013;84: 465–470. doi: 10.1016/j.resuscitation.2012.12.016 23295778

7. Subbe CP, Kruger M, Rutherford P, Gemmel L. Validation of a modified Early Warning Score in medical admissions. QJM. 2001;94: 521–526. doi: 10.1093/qjmed/94.10.521 11588210

8. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315: 801–810. doi: 10.1001/jama.2016.0287 26903338

9. Bone RC, Sibbald WJ, Sprung CL. The ACCP-SCCM consensus conference on sepsis and organ failure. Chest. 1992;101: 1481–1483. doi: 10.1378/chest.101.6.1481 1600757

10. Bianchi W, Dugas AF, Hsieh YH, Saheed M, Hill P, Lindauer C, et al. Revitalizing a vital sign: improving detection of tachypnea at primary triage. Ann Emerg Med. 2013;61: 37–43. doi: 10.1016/j.annemergmed.2012.05.030 22738682

11. Mukkamala SG, Gennings C, Wenzel RP. R = 20: bias in the reporting of respiratory rates. Am J Emerg Med. 2008;26: 237–239.

12. Leuvan CH, Mitchell I. Missed opportunities? An observational study of vital sign measurements. Crit Care Resusc. 2008;10: 111–115. 18522524

13. Flenady T, Dwyer T, Applegarth J. Explaining transgression in respiratory rate observation methods in the emergency department: A classic grounded theory analysis. Int J Nurs Stud. 2017;74: 67–75. doi: 10.1016/j.ijnurstu.2017.06.001 28622531

14. Semler MW, Stover DG, Copland AP, Hong G, Johnson MJ, Kriss MS, et al. Flash mob research: a single-day, multicenter, resident-directed study of respiratory rate. Chest. 2013;143: 1740–1744. doi: 10.1378/chest.12-1837 23197319

15. Nielsen LG, Folkestad L, Brodersen JB, Brabrand M. Inter-Observer Agreement in Measuring Respiratory Rate. PLoS One. 2015;10: e0129493. doi: 10.1371/journal.pone.0129493 26090961

16. Koo TK, Li MY. A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. J Chiropr Med. 2016;15: 155–163. doi: 10.1016/j.jcm.2016.02.012 27330520

17. McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb). 2012;22: 276–282.

18. Brabrand M, Hallas P, Folkestad L, Lautrup-Larsen CH, Brodersen JB. Measurement of respiratory rate by multiple raters in a clinical setting is unreliable: A cross-sectional simulation study. J Crit Care. 2018;44: 404–406. doi: 10.1016/j.jcrc.2017.12.020 29310091

19. Edmonds ZV, Mower WR, Lovato LM, Lomeli R. The reliability of vital sign measurements. Ann Emerg Med. 2002;39: 233–237. doi: 10.1067/mem.2002.122017 11867974

20. Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A, et al. Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315: 762–774. doi: 10.1001/jama.2016.0288 26903335

21. Fieselmann JF, Hendryx MS, Helms CM, Wakefield DS. Respiratory rate predicts cardiopulmonary arrest for internal medicine inpatients. J Gen Intern Med. 1993;8: 354–360. doi: 10.1007/bf02600071 8410395


Článek vyšel v časopise

PLOS One


2019 Číslo 10

Nejčtenější v tomto čísle

Tomuto tématu se dále věnují…


Kurzy

Zvyšte si kvalifikaci online z pohodlí domova

Léčba bolesti v ordinaci praktického lékaře
nový kurz
Autoři: MUDr. PhDr. Zdeňka Nováková, Ph.D.

Revmatoidní artritida: včas a k cíli
Autoři: MUDr. Heřman Mann

Jistoty a nástrahy antikoagulační léčby aneb kardiolog - neurolog - farmakolog - nefrolog - právník diskutují
Autoři: doc. MUDr. Štěpán Havránek, Ph.D., prof. MUDr. Roman Herzig, Ph.D., doc. MUDr. Karel Urbánek, Ph.D., prim. MUDr. Jan Vachek, MUDr. et Mgr. Jolana Těšínová, Ph.D.

Léčba akutní pooperační bolesti
Autoři: doc. MUDr. Jiří Málek, CSc.

Nové antipsychotikum kariprazin v léčbě schizofrenie
Autoři: prof. MUDr. Cyril Höschl, DrSc., FRCPsych.

Všechny kurzy
Kurzy Doporučená témata Časopisy
Přihlášení
Zapomenuté heslo

Nemáte účet?  Registrujte se

Zapomenuté heslo

Zadejte e-mailovou adresu se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.

Přihlášení

Nemáte účet?  Registrujte se