Effect of context on respiratory rate measurement in identifying non‐severe pneumonia in African children
Open Access
- 27 March 2015
- journal article
- Published by Wiley in Tropical Medicine & International Health
- Vol. 20 (6), 757-765
- https://doi.org/10.1111/tmi.12492
Abstract
Cough or difficult breathing and an increased respiratory rate for their age are the commonest indications for outpatient antibiotic treatment in African children. We aimed to determine whether respiratory rate was likely to be transiently raised by a number of contextual factors in a busy clinic leading to inaccurate diagnosis. Respiratory rates were recorded in children aged 2–59 months presenting with cough or difficulty breathing to one of the two busy outpatient clinics and then repeated at 10‐min intervals over 1 h in a quiet setting. One hundred and sixty‐seven children were enrolled with a mean age of 7.1 (SD ± 2.9) months in infants and 27.6 (SD ± 12.8) months in children aged 12–59 months. The mean respiratory rate declined from 42.3 and 33.6 breaths per minute (bpm) in the clinic to 39.1 and 32.6 bpm after 10 min in a quiet room and to 39.2 and 30.7 bpm (P < 0.001) after 60 min in younger and older children, respectively. This resulted in 11/13 (85%) infants and 2/15 (13%) older children being misclassified with non‐severe pneumonia. In a random effects linear regression model, the variability in respiratory rate within children (42%) was almost as much as the variability between children (58%). Changing the respiratory rates cut‐offs to higher thresholds resulted in a small reduction in the proportion of non‐severe pneumonia mis‐classifications in infants. Noise and other contextual factors may cause a transient increase in respiratory rate and consequently misclassification of non‐severe pneumonia. However, this effect is less pronounced in older children than infants. Respiratory rate is a difficult sign to measure as the variation is large between and within children. More studies of the accuracy and utility of respiratory rate as a proxy for non‐severe pneumonia diagnosis in a busy clinic are needed.Keywords
Funding Information
- Wellcome Trust (087540)
This publication has 26 references indexed in Scilit:
- Treatment guided by rapid diagnostic tests for malaria in Tanzanian children: safety and alternative bacterial diagnosesMalaria Journal, 2011
- Setting Research Priorities to Reduce Global Mortality from Childhood Pneumonia by 2015PLoS Medicine, 2011
- Reduction of anti-malarial consumption after rapid diagnostic tests implementation in Dar es Salaam: a before-after and cluster randomized controlled studyMalaria Journal, 2011
- Causes of deaths in children younger than 5 years in China in 2008The Lancet, 2010
- Out with the old, in with the new: the utility of rapid diagnostic tests for malaria diagnosis in AfricaTransactions of the Royal Society of Tropical Medicine and Hygiene, 2009
- Progress in introduction of pneumococcal conjugate vaccine--worldwide, 2000-2008.2008
- Epidemiology and etiology of childhood pneumoniaPublished by WHO Press ,2008
- Treatment of malaria restricted to laboratory-confirmed cases: a prospective cohort study in Ugandan childrenMalaria Journal, 2007
- Elimination of Haemophilus influenzae type b (Hib) disease from The Gambia after the introduction of routine immunisation with a Hib conjugate vaccine: a prospective studyThe Lancet, 2005
- Epidemiology and etiology of childhood pneumonia in 2010: estimates of incidence, severe morbidity, mortality, underlying risk factors and causative pathogens for 192 countriesJournal of Global Health