Loots Feike J, Dekker Irma, Wang Ruo Chen, van Zanten Arthur Rh, Hopstaken Rogier M, Verheij Theo Jm, Giesen Paul, Smits Marleen
Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Nijmegen, The Netherlands.
BJGP Open. 2022 Dec 20;6(4). doi: 10.3399/BJGPO.2022.0029. Print 2022 Dec.
Tachypnoea in acutely ill patients can be an early sign of a life-threatening condition such as sepsis. Routine measurement of the respiratory rate by GPs might improve the recognition of sepsis.
To assess the accuracy and feasibility of respiratory rate measurements by GPs.
DESIGN & SETTING: Observational cross-sectional mixed-methods study in the setting of out-of-hours (OOH) home visits at three GP cooperatives in The Netherlands.
GPs were observed during the assessment of acutely ill patients, and semi-structured interviews were performed. The GP-assessed respiratory rate was compared with a reference measurement. In the event that the respiratory rate was not counted, GPs were asked to estimate the rate (dichotomised as ≥22 breaths per minute or <22 breaths per minute).
Observations of 130 acutely ill patients were included, and 14 GPs were interviewed. In 33 patients (25%), the GP counted the respiratory rate. A mean difference of 0.27 breaths per minute (95% confidence interval [CI] = -5.7 to 6.3) with the reference measurement was found. At a cut-off point of ≥22 breaths per minute, a sensitivity of 86% (95% CI = 57% to 98%) was found when the GP counted the rate, and a sensitivity of 43% (95% CI = 22% to 66%) when GPs estimated respiratory rates. GPs reported both medical and practical reasons for not routinely measuring the respiratory rate.
GPs are aware of the importance of assessing the respiratory rate of acutely ill adult patients, and counted measurements are accurate. However, in most patients the respiratory rate was not counted, and the rate was often underestimated when estimated.
急症患者呼吸急促可能是脓毒症等危及生命状况的早期迹象。全科医生（GP）常规测量呼吸频率可能会提高对脓毒症的识别率。
评估全科医生测量呼吸频率的准确性和可行性。
在荷兰三家全科医生合作社进行的非工作时间（OOH）上门访视的观察性横断面混合方法研究。
在评估急症患者期间对全科医生进行观察，并进行半结构化访谈。将全科医生评估的呼吸频率与参考测量值进行比较。如果未计数呼吸频率，则要求全科医生估计频率（分为每分钟≥22次呼吸或<22次呼吸）。
纳入了对130名急症患者的观察，并对14名全科医生进行了访谈。在33名患者（25%）中，全科医生计数了呼吸频率。与参考测量值相比，平均差异为每分钟0.27次呼吸（95%置信区间[CI]=-5.7至6.3）。在每分钟≥22次呼吸的截断点，当全科医生计数频率时，敏感性为86%（95%CI=57%至98%），当全科医生估计呼吸频率时，敏感性为43%（95%CI=22%至66%）。全科医生报告了不常规测量呼吸频率的医学和实际原因。
全科医生意识到评估急症成年患者呼吸频率的重要性，计数测量是准确的。然而，在大多数患者中未计数呼吸频率，估计时频率往往被低估。
