Tack Bieke, Vita Daniel, Mbaki Thomas Nsema, Lunguya Octavie, Toelen Jaan, Jacobs Jan
Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium.
Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium.
Diagnostics (Basel). 2021 Nov 10;11(11):2078. doi: 10.3390/diagnostics11112078.
To improve the early recognition of danger signs in children with severe febrile illness in low resource settings, WHO promotes automated respiratory rate (RR) counting, but its performance is unknown in this population. Therefore, we prospectively evaluated the field performance of automated point-of-care plethysmography-based RR counting in hospitalized children with severe febrile illness (<5 years) in DR Congo. A trained research nurse simultaneously counted the RR manually (comparative method) and automatically with the Masimo Rad G pulse oximeter. Valid paired RR measurements were obtained in 202 (83.1%) children, among whom 43.1% (87/202) had fast breathing according to WHO criteria based on manual counting. Automated counting frequently underestimated the RR (median difference of -1 breath/minute; p2.5-p97.5 limits of agreement: -34-6), particularly at higher RR. This resulted in a failure to detect fast breathing in 24.1% (21/87) of fast breathing children (positive percent agreement: 75.9%), which was not explained by clinical characteristics ( > 0.05). Children without fast breathing were mostly correctly classified (negative percent agreement: 98.3%). In conclusion, in the present setting the automated RR counter performed insufficiently to facilitate the early recognition of danger signs in children with severe febrile illness, given wide limits of agreement and a too low positive percent agreement.
为提高资源匮乏地区重症发热性疾病患儿危险体征的早期识别率，世界卫生组织推广自动呼吸频率（RR）计数，但该方法在这一人群中的表现尚不清楚。因此，我们前瞻性地评估了基于即时检测体积描记法的自动RR计数在刚果民主共和国住院的重症发热性疾病（<5岁）患儿中的现场表现。一名经过培训的研究护士同时手动计数RR（比较方法），并使用Masimo Rad G脉搏血氧仪自动计数RR。在202名（83.1%）患儿中获得了有效的配对RR测量值，其中根据手动计数，43.1%（87/202）的患儿呼吸急促。自动计数经常低估RR（中位数差异为-1次/分钟；一致性界限的p2.5-p97.5：-34-6），尤其是在RR较高时。这导致在24.1%（21/87）呼吸急促的患儿中未能检测到呼吸急促（阳性百分比一致性：75.9%），这无法用临床特征解释（p>0.05）。无呼吸急促的患儿大多被正确分类（阴性百分比一致性：98.3%）。总之，在当前环境下，鉴于一致性界限宽泛且阳性百分比一致性过低，自动RR计数器在促进重症发热性疾病患儿危险体征的早期识别方面表现不佳。
