G428 Variation in respiratory rate measurments in children

Background Respiratory rate (RR) is an important vital sign used in the initial and ongoing assessment of unwell children. Measuring respiratory rate can be difficult and time consuming, especially in an uncooperative child. There are concerns that there may be high levels of inconsistencies in measurements of respiratory rate. This may impact greatly on the child, their clinical assessment and subsequent management, and the accurate identification of possible deterioration. Aim To determine the reliability of a respiratory rate count on a child when assessed by three independent observers. Method From August 2016 to October 2016 the respiratory rate of 169 children was measured by three independent observers in one tertiary children’s hospital. The first respiratory rate was taken by different healthcare professionals from within the hospital using their own method of measurement. A further count of respiratory rate was then taken by two different observers simultaneously within 30 min of the first measurement. They measured the respiratory rate using the WHO recommended method of measurement by observing chest movements over 60 s. All observers were blinded to each of the others’ measurements. Results A total of 507 respiratory rate measurements were taken on 169 children aged between 3 days and 15 years. The 95% limits of agreement between the first RR measurement and second and third measurements was 10.15 to 17.68 and 11.36 to 18.73 respectively. For simultaneous measurements the 95% limits of agreement were 7.11 to 6.95, meaning that that the difference in measurements could have been anything from 7 breaths less to 6 breaths more. Significantly, in 25% of the children the difference in the measured RR was such that the child would not have been assessed as being tachypnoeic by one or more of the three observers. Conclusion There exists a large variation in respiratory rate measurements taken in children. The agreement between measurements and the identification of tachypnoea was poor. The effect that this variation may have on the clinical assessment of a child is significant. These findings highlight the need for a robust review of our current reliance and interpretation of such an important vital sign.