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Baumann S, Stone R, Kim JYM. Introducing the Pi-CON Methodology to Overcome Usability Deficits during Remote Patient Monitoring. SENSORS (BASEL, SWITZERLAND) 2024; 24:2260. [PMID: 38610471 PMCID: PMC11014368 DOI: 10.3390/s24072260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024]
Abstract
The adoption of telehealth has soared, and with that the acceptance of Remote Patient Monitoring (RPM) and virtual care. A review of the literature illustrates, however, that poor device usability can impact the generated data when using Patient-Generated Health Data (PGHD) devices, such as wearables or home use medical devices, when used outside a health facility. The Pi-CON methodology is introduced to overcome these challenges and guide the definition of user-friendly and intuitive devices in the future. Pi-CON stands for passive, continuous, and non-contact, and describes the ability to acquire health data, such as vital signs, continuously and passively with limited user interaction and without attaching any sensors to the patient. The paper highlights the advantages of Pi-CON by leveraging various sensors and techniques, such as radar, remote photoplethysmography, and infrared. It illustrates potential concerns and discusses future applications Pi-CON could be used for, including gait and fall monitoring by installing an omnipresent sensor based on the Pi-CON methodology. This would allow automatic data collection once a person is recognized, and could be extended with an integrated gateway so multiple cameras could be installed to enable data feeds to a cloud-based interface, allowing clinicians and family members to monitor patient health status remotely at any time.
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Affiliation(s)
| | | | - Joseph Yun-Ming Kim
- Industrial and Manufacturing Systems Engineering, Iowa State University, 2529 Union Dr, Ames, IA 50011, USA; (S.B.); (R.S.)
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Vianney J, Nakitende I, Nabiryo J, Kalema H, Namuleme S, Kellett J. Implementation of a fast triage score for patients arriving to a low resource hospital in Uganda. Afr J Emerg Med 2024; 14:45-50. [PMID: 38283235 PMCID: PMC10818058 DOI: 10.1016/j.afjem.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/07/2023] [Accepted: 01/05/2024] [Indexed: 01/30/2024] Open
Abstract
Background The Kitovu Fast Triage (KFT) score predicts imminent mortality from mental status, gait and either respiratory rate or oxygen status. As some non-life-threatening conditions require immediate attention, the South African Triage System (SATS) assigns arbitrary rankings of urgency for specific patient presentations. Aim Establish the feasibility of determining and then comparing the KFT score and explicitly defined SATS urgency rankings. Methods A computerized proforma used standardized methods of assessing and measuring mental status and gait, and respiratory rate and collected explicitly defined clinical presentations and SATS urgency rankings on 4,842 patients at the time of their arrival to the hospital. Results 75 % of patients were awake and able to count the months backwards from December to September. Respiratory rates measured by a computer application had no clustering of values or digit preference; however, oximetry failed in 14 % of patients, making the score based on respiratory rate the most practical in our setting. Determining the SATS acuity ranking and both KFT scores usually took <90 s; the commonest complaints were pain, dyspnoea, and fever, which often occurred together; overall 3574 (73.8 %) patients had at least one of these symptoms as did 96.4 % of those with the highest KFT score based on respiratory rate. 12 % of patients with the lowest KFT score based on respiratory rate had one or more very urgent SATS rankings, 52 % of whom had non-severe chest pain. Only 5.7 % of patients complaining of fever had a temperature >38 °C. Conclusion Whilst the KFT score based on respiratory rate could be rapidly determined in all patients, it identified some patients as low acuity who had very urgent SATS rankings. However, most of these patients had non-severe chest pain, which may not be a very urgent presentation in our setting as ischaemic heart disease remains uncommon in sub-Saharan Africa.
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Affiliation(s)
- Jjukira Vianney
- Emergency and out-patient department, Kitovu Hospital, Masaka, Uganda
| | | | - Joan Nabiryo
- Emergency and out-patient department, Kitovu Hospital, Masaka, Uganda
| | - Henry Kalema
- Information Technology Department, Kitovu Hospital, Masaka, Uganda
| | | | - John Kellett
- Department of Emergency Medicine, University Hospital Odense, Denmark
| | - Kitovu Hospital Study Group
- Emergency and out-patient department, Kitovu Hospital, Masaka, Uganda
- Information Technology Department, Kitovu Hospital, Masaka, Uganda
- Directorate of Nursing, Kitovu Hospital, Masaka, Uganda
- Department of Emergency Medicine, University Hospital Odense, Denmark
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Rawat A, Ameha A, Karlström J, Taddesse L, Negeri EL, Detjen A, Gandrup-Marino K, Mataruse N, Källander K, Tariku A. Health System Considerations for Community-Based Implementation of Automated Respiratory Counters to Identify Childhood Pneumonia in 5 Regions of Ethiopia: A Qualitative Study. Int J Health Policy Manag 2023; 12:7385. [PMID: 38618793 PMCID: PMC10699823 DOI: 10.34172/ijhpm.2023.7385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/30/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND In Ethiopia, childhood pneumonia is diagnosed in primary healthcare settings by measuring respiratory rate (RR) along with the presence of cough, chest indrawing, difficulty breathing, and fast breathing. Our aim was to identify health system-level lessons from implementing two automated RR counters, Children's Automated Respiration Monitor (ChARM) by Phillips® and Rad-G by Masimo®, to provide considerations for integrating such devices into child health programmes and health systems. This study was part of an initiative called the Acute Respiratory Infection Diagnostic Aids (ARIDA). METHODS Key informant interviews (KIIs) were conducted with 57 participants (health workers in communities and facilities, trainers of health workers, district management, and key decision-makers) in five regions of Ethiopia. Data were analyzed in ATLAS.ti using thematic content analysis and themes were categorized using the Tanahashi bottleneck analysis. RESULTS All participants recommended scaling up the ARIDA initiative nationally as part of Integrated Management of Newborn and Childhood Illness (IMNCI) in primary healthcare. Health workers perceived the devices as: time saving, acceptable by parents and children, and facilitating diagnosis and referrals. Health workers perceived an increased demand for services and reduced numbers of sick children not seeking care. Participants recommended increasing the number of devices distributed and health workers trained. Strengthening drug supply chains, improving oxygen gas availability, and strengthening referral networks would maximize perceived benefits. While training improved knowledge, more supportive supervision, integration with current guidelines and more guidance related to community engagement was recommended. CONCLUSION Automatic RR counters for the decentralized diagnosis of childhood pneumonia could have positive impact on improving the quality of diagnosis and management of pneumonia in children. However, the study has shown that a health system approach is required to ensure all steps along the pneumonia pathway are adequate, including drug and oxygen supply, community engagement, health worker training and support, and referral pathways.
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Affiliation(s)
- Angeli Rawat
- UNICEF Supply Division Innovation Unit, Copenhagen, Denmark
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Agazi Ameha
- UNICEF Ethiopia Country Office, Addis Ababa, Ethiopia
| | - Jonas Karlström
- UNICEF Supply Division Innovation Unit, Copenhagen, Denmark
- Global Programmes and Research, SingHealth Duke-NUS Global Health Institute, Duke-NUS, Singapore, Singapore
| | - Lisanu Taddesse
- Federal Ministry of Health of Ethiopia, Addis Ababa, Ethiopia
| | | | - Anne Detjen
- Child and Community Health Unit, Health Programme Group, UNICEF, New York City, NY, USA
| | | | | | - Karin Källander
- Digital Health and Health Information Systems Unit, Health Programme Group, UNICEF, New York City, NY, USA
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Abraham Tariku
- Federal Ministry of Health of Ethiopia, Addis Ababa, Ethiopia
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Spurr R, Ng E, Onchiri FM, Rapha B, Nakatumba-Nabende J, Rosenfeld M, Najjingo I, Stout JW, Nantanda R, Ellington LE. Performance and usability of a new mobile application for measuring respiratory rate in young children with acute lower respiratory infections. Pediatr Pulmonol 2022; 57:3009-3016. [PMID: 35996862 PMCID: PMC10583740 DOI: 10.1002/ppul.26125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 07/18/2022] [Accepted: 08/17/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Respiratory rate (RR) measurement is critical to diagnosing pneumonia in resource-constrained settings, but accurate RR measurement is challenging. The acute lower respiratory illness treatment and evaluation (ALRITE) mobile phone application (app), designed to help healthcare workers (HCWs) manage pediatric respiratory illnesses, includes a semiautomated RR counter. This study aimed to evaluate the accuracy and usability of the ALRITE RR counter and a commercially available RR counter app, RRate, with a reference standard. METHODS This was a cross-sectional observational study of HCWs. Participants used both apps to measure the RR of pediatric patients from standardized videos. The reference standard was determined by consensus of a manual 1-min count by two providers. We assessed agreement using Spearman's rank correlation coefficient and constructed Bland-Altman plots to determine bias and limits of agreement. Participants completed a usability survey. RESULTS Thirty-nine HCWs participated. The agreement between the apps and reference standard (Spearman's coefficient) was 0.83 (95% confidence interval [CI]: 0.78-0.87) for ALRITE and 0.62 (95% CI: 0.52-0.70) for RRate. ALRITE had a bias of -2 breaths/min (lower limit of agreement [LoA] -16 to +12) and RRate had a bias of -0.4 breaths/min (LoA -24 to +23) compared to the reference standard. Both apps had a poorer agreement at higher RRs. Based on usability survey responses, 95% found ALRITE easy to use. CONCLUSIONS The ALRITE RR counter has acceptable accuracy for counting RR in infants with respiratory distress, appears to be more accurate than a commercially available option, and was user-friendly. The ALRITE RR counter is a promising tool for meriting evaluation in real-world settings.
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Affiliation(s)
- Rebecca Spurr
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Erin Ng
- Center for Clinical and Translational Research, Seattle Children’s Hospital, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Frankline M. Onchiri
- Center for Clinical and Translational Research, Seattle Children’s Hospital, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Ben Rapha
- Department of Computer Science, Makerere University School of Computing and Information Technology, Kampala, Uganda
| | - Joyce Nakatumba-Nabende
- Department of Computer Science, Makerere University School of Computing and Information Technology, Kampala, Uganda
| | - Margaret Rosenfeld
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
- Center for Clinical and Translational Research, Seattle Children’s Hospital, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Irene Najjingo
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - James W. Stout
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Rebecca Nantanda
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Laura E. Ellington
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
- Center for Clinical and Translational Research, Seattle Children’s Hospital, Seattle Children’s Research Institute, Seattle, Washington, USA
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Khan AM, Ahmed S, Chowdhury NH, Islam MS, McCollum ED, King C, Shi T, Nahar K, Simpson R, Ahmed A, Rahman MM, Baqui AH, Cunningham S, Campbell H. Developing a video expert panel as a reference standard to evaluate respiratory rate counting in paediatric pneumonia diagnosis: protocol for a cross-sectional study. BMJ Open 2022; 12:e067389. [PMID: 36379660 PMCID: PMC9668034 DOI: 10.1136/bmjopen-2022-067389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Manual counting of respiratory rate (RR) in children is challenging for health workers and can result in misdiagnosis of pneumonia. Some novel RR counting devices automate the counting of RR and classification of fast breathing. The absence of an appropriate reference standard to evaluate the performance of these devices is a challenge. If good quality videos could be captured, with RR interpretation from these videos systematically conducted by an expert panel, it could act as a reference standard. This study is designed to develop a video expert panel (VEP) as a reference standard to evaluate RR counting for identifying pneumonia in children. METHODS AND ANALYSIS Using a cross-sectional design, we will enrol children aged 0-59 months presenting with suspected pneumonia at different levels of health facilities in Dhaka and Sylhet, Bangladesh. We will videorecord a physician/health worker counting RR manually and also using an automated RR counter (Children's Automated Respiration Monitor) from each child. We will establish a standard operating procedure for capturing quality videos, make a set of reference videos, and train and standardise the VEP members using the reference videos. After that, we will assess the performance of the VEP as a reference standard to evaluate RR counting. We will calculate the mean difference and proportions of agreement within±2 breaths per minute and create Bland-Altman plots with limits of agreement between VEP members. ETHICS AND DISSEMINATION The study protocol was approved by the National Research Ethics Committee of Bangladesh Medical Research Council, Bangladesh (registration number: 39315022021) and Edinburgh Medical School Research Ethics Committee (EMREC), Edinburgh, UK (REC Reference: 21-EMREC-040). Dissemination of the study findings will be through conference presentations and publications in peer-reviewed scientific journals.
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Affiliation(s)
- Ahad Mahmud Khan
- Usher Institute, The University of Edinburgh, Edinburgh, UK
- Projahnmo Research Foundation, Dhaka, Bangladesh
| | - Salahuddin Ahmed
- Usher Institute, The University of Edinburgh, Edinburgh, UK
- Projahnmo Research Foundation, Dhaka, Bangladesh
| | | | | | - Eric D McCollum
- Department of Paediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Carina King
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Ting Shi
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Kamrun Nahar
- Department of Paediatrics, Shaheed Suhrawardi Medical College Hospital, Dhaka, Bangladesh
| | | | - Ayaz Ahmed
- Royal Hospital for Children, Glasgow, UK
| | - Md Mozibur Rahman
- Department of Neonatology, Institute of Child and Mother Health, Dhaka, Bangladesh
| | - Abdullah H Baqui
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Steve Cunningham
- Department of Paediatric Respiratory Medicine, The University of Edinburgh Centre for Inflammation Research, Edinburgh, UK
| | - Harry Campbell
- Usher Institute, The University of Edinburgh, Edinburgh, UK
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Dale NM, Ashir GM, Maryah LB, Shepherd S, Tomlinson G, Briend A, Zlotkin S, Parshuram C. Development and an initial validation of the Responses to Illness Severity Quantification (RISQ) score for severely malnourished children. Acta Paediatr 2022; 111:1752-1763. [PMID: 35582782 PMCID: PMC9545493 DOI: 10.1111/apa.16410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/02/2022] [Accepted: 05/16/2022] [Indexed: 12/01/2022]
Abstract
Aim To develop and perform an initial validation of a score to measure the severity of illness in hospitalised children with severe acute malnutrition (SAM). Methods A prospective study enrolled SAM children aged 6–59 months hospitalised in Borno State, Nigeria. Candidate items associated with inpatient mortality were combined and evaluated as candidate scores. Clinical and statistical methods were used to identify a preferred score. Results The 513 children enrolled had a mean age of 15.6 months of whom 48 (9%) died. Seven of the 10 evaluated items were significantly associated with mortality. Five different candidate scores were tested. The final score, Responses to Illness Severity Quantification (RISQ), included seven items: heart rate, respiratory rate, respiratory effort, oxygen saturation, oxygen delivery, temperature and level of consciousness. The mean RISQ score on admission was 2.6 in hospital survivors and 7.3 for children dying <48 h. RISQ scores <24 h before death had an area under the receiver operating characteristic curve (AUROC) of 0.93. The RISQ score performed similarly across differing clinical conditions with AUROCs 0.77–0.98 for all conditions except oedema. Conclusion The RISQ score can identify high‐risk malnourished children at and during hospital admission. Clinical application may help prioritise care and potentially improve survival.
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Affiliation(s)
- Nancy M. Dale
- Centre for Global Child Health, Hospital for Sick Children Toronto Canada
- Child Health Evaluative Sciences SickKids Research Institute Toronto Canada
- Center for Safety Research Toronto Ontario Canada
- Tampere Center for Child, Adolescent, and Maternal Health Research: Global Health Group University of Tampere Tampere Finland
| | - Garba Mohammed Ashir
- Department of Pediatrics University of Maiduguri Teaching Hospital Maiduguri Nigeria
| | - Lawan Bukar Maryah
- Department of Pediatrics University of Maiduguri Teaching Hospital Maiduguri Nigeria
| | | | | | - André Briend
- Tampere Center for Child, Adolescent, and Maternal Health Research: Global Health Group University of Tampere Tampere Finland
- Department of Nutrition, Exercise and Sports, Faculty of Science University of Copenhagen Frederiksberg Denmark
| | - Stanley Zlotkin
- Centre for Global Child Health, Hospital for Sick Children Toronto Canada
- Child Health Evaluative Sciences SickKids Research Institute Toronto Canada
- Department of Paediatrics Hospital for Sick Children and University of Toronto Toronto Canada
| | - Christopher Parshuram
- Child Health Evaluative Sciences SickKids Research Institute Toronto Canada
- Center for Safety Research Toronto Ontario Canada
- Department of Critical Care Medicine Hospital for Sick Children Toronto Canada
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Khan AM, O’Donald A, Shi T, Ahmed S, McCollum ED, King C, Baqui AH, Cunningham S, Campbell H. Accuracy of non-physician health workers in respiratory rate measurement to identify paediatric pneumonia in low- and middle-income countries: A systematic review and meta-analysis. J Glob Health 2022. [PMCID: PMC9037577 DOI: 10.7189/jogh.12.04037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Ahad M Khan
- Projahnmo Research Foundation, Dhaka, Bangladesh
- The University of Edinburgh, Edinburgh, UK
| | | | - Ting Shi
- The University of Edinburgh, Edinburgh, UK
| | - Salahuddin Ahmed
- Projahnmo Research Foundation, Dhaka, Bangladesh
- The University of Edinburgh, Edinburgh, UK
| | - Eric D McCollum
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Abdullah H Baqui
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Njeru CM, Ansermino JM, Macharia WM, Dunsmuir DT. Variability of respiratory rate measurements in neonates- every minute counts. BMC Pediatr 2022; 22:16. [PMID: 34980049 PMCID: PMC8722355 DOI: 10.1186/s12887-021-03087-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background Respiratory rate is difficult to measure, especially in neonates who have an irregular breathing pattern. The World Health Organisation recommends a one-minute count, but there is limited data to support this length of observation. We sought to evaluate agreement between the respiratory rate (RR) derived from capnography in neonates, over 15 s, 30 s, 120 s and 300 s, against the recommended 60 s. Methods Neonates at two hospitals in Nairobi were recruited and had capnograph waveforms recorded using the Masimo Rad 97. A single high quality 5 min epoch was randomly chosen from each subject. For each selected epoch, the mean RR was calculated using a breath-detection algorithm applied to the waveform. The RR in the first 60 s was compared to the mean RR measured over the first 15 s, 30 s, 120 s, full 300 s, and last 60 s. We calculated bias and limits of agreement for each comparison and used Bland-Altman plots for visual comparisons. Results A total of 306 capnographs were analysed from individual subjects. The subjects had a median gestation age of 39 weeks with slightly more females (52.3%) than males (47.7%). The majority of the population were term neonates (70.1%) with 39 (12.8%) having a primary respiratory pathology. There was poor agreement between all the comparisons based on the limits of agreement [confidence interval], ranging between 11.9 [− 6.79 to 6.23] breaths per minute in the one versus 2 min comparison, and 34.7 [− 17.59 to 20.53] breaths per minute in the first versus last minute comparison. Worsening agreement was observed in plots with higher RRs. Conclusions Neonates have high variability of RR, even over a short period of time. A slight degradation in the agreement is noted over periods shorter than 1 min. However, this is smaller than observations done 3 min apart in the same subject. Longer periods of observation also reduce agreement. For device developers, precise synchronization is needed when comparing devices to reduce the impact of RR variation. For clinicians, where possible, continuous or repeated monitoring of neonates would be preferable to one time RR measurements.
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Affiliation(s)
| | - J Mark Ansermino
- The University of British Columbia, 4480 Oak Street, Vancouver, British Columbia, Canada
| | | | - Dustin T Dunsmuir
- The University of British Columbia, 4480 Oak Street, Vancouver, British Columbia, Canada
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Tack B, Vita D, Mbaki TN, Lunguya O, Toelen J, Jacobs J. Performance of Automated Point-of-Care Respiratory Rate Counting versus Manual Counting in Children under Five Admitted with Severe Febrile Illness to Kisantu Hospital, DR Congo. Diagnostics (Basel) 2021; 11:2078. [PMID: 34829427 PMCID: PMC8623579 DOI: 10.3390/diagnostics11112078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
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 (p > 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.
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Affiliation(s)
- Bieke Tack
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium;
- Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium
| | - Daniel Vita
- Hôpital Général de Référence Saint Luc de Kisantu, Kisantu, Democratic Republic of the Congo; (D.V.); (T.N.M.)
| | - Thomas Nsema Mbaki
- Hôpital Général de Référence Saint Luc de Kisantu, Kisantu, Democratic Republic of the Congo; (D.V.); (T.N.M.)
| | - Octavie Lunguya
- Department of Microbiology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo;
- Department of Medical Biology, University Teaching Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jaan Toelen
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium;
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium;
- Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium
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10
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Ranta J, Ilén E, Palmu K, Salama J, Roienko O, Vanhatalo S. An openly available wearable, a diaper cover, monitors infant's respiration and position during rest and sleep. Acta Paediatr 2021; 110:2766-2771. [PMID: 34146357 DOI: 10.1111/apa.15996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 12/01/2022]
Abstract
AIM To describe and test the accuracy of respiratory rate assessment in long-term surveillance using an open-source infant wearable, NAPping PAnts (NAPPA). METHODS We recorded 24 infants aged 1-9 months using our newly developed infant wearable that is a diaper cover with an integrated programmable electronics with accelerometer and gyroscope sensors. The sensor collects child's respiration rate (RR), activity and body posture in 30-s epochs, to be downloaded afterwards into a mobile phone application. An automated RR quality measure was also implemented using autocorrelation function, and the accuracy of RR estimate was compared with a reference obtained from the simultaneously recorded capnography signal that was part of polysomnography recordings. RESULTS Altogether 88 h 27 min of data were recorded, and 4147 epochs (39% of all data) were accepted after quality detection. The median of patient wise mean absolute errors in RR estimates was 1.5 breaths per minute (interquartile range 1.1-2.6 bpm), and the Blandt-Altman analysis indicated an RR bias of 0.0 bpm with the 95% limits of agreement of -5.7-5.7 bpm. CONCLUSION Long-term monitoring of RR and posture can be done with reasonable accuracy in out-of-hospital settings using NAPPA, an openly available infant wearable.
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Affiliation(s)
- Jukka Ranta
- BABA Center Children's Hospital Helsinki University Hospital and University of Helsinki Helsinki Finland
| | - Elina Ilén
- Department of Design Aalto University Espoo Finland
| | - Kirsi Palmu
- BABA Center Children's Hospital Helsinki University Hospital and University of Helsinki Helsinki Finland
- Department of Clinical Neurophysiology HUS Medical Imaging Center University of HelsinkiHelsinki University Hospital and University of Helsinki Helsinki Finland
| | - Jonna Salama
- BABA Center Children's Hospital Helsinki University Hospital and University of Helsinki Helsinki Finland
- Department of Clinical Neurophysiology HUS Medical Imaging Center University of HelsinkiHelsinki University Hospital and University of Helsinki Helsinki Finland
| | - Oleksii Roienko
- BABA Center Children's Hospital Helsinki University Hospital and University of Helsinki Helsinki Finland
| | - Sampsa Vanhatalo
- BABA Center Children's Hospital Helsinki University Hospital and University of Helsinki Helsinki Finland
- Department of Clinical Neurophysiology HUS Medical Imaging Center University of HelsinkiHelsinki University Hospital and University of Helsinki Helsinki Finland
- Neuroscience Center University of Helsinki Helsinki Finland
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11
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Baker K, Petzold M, Mucunguzi A, Wharton-Smith A, Dantzer E, Habte T, Matata L, Nanyumba D, Okwir M, Posada M, Sebsibe A, Nicholson J, Marasciulo M, Izadnegahdar R, Alfvén T, Källander K. Performance of five pulse oximeters to detect hypoxaemia as an indicator of severe illness in children under five by frontline health workers in low resource settings - A prospective, multicentre, single-blinded, trial in Cambodia, Ethiopia, South Sudan, and Uganda. EClinicalMedicine 2021; 38:101040. [PMID: 34368660 PMCID: PMC8326731 DOI: 10.1016/j.eclinm.2021.101040] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/30/2021] [Accepted: 07/06/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Low blood oxygen saturation (SpO2), or hypoxaemia, is an indicator of severe illness in children. Pulse oximetry is a globally accepted, non-invasive method to identify hypoxaemia, but rarely available outside higher-level facilities in resource-constrained countries. This study aims to evaluate the performance of different types of pulse oximeters amongst frontline health workers in Cambodia, Ethiopia, South Sudan, and Uganda. METHODS Five pulse oximeters (POx) which passed laboratory testing, out of an initial 32 potential pulse oximeters, were evaluated by frontline health workers for performance, defined as agreement between the SpO2 measurements of the test device and the reference standard. The study protocol is registered with the Australia New Zealand Clinical Trials Registry (Ref: ACTRrn12615000348550). FINDINGS Two finger-tip pulse oximeters (Contec and Devon), two handheld pulse oximeters (Lifebox and Utech), and one phone pulse oximeter (Masimo) passed the laboratory testing. They were evaluated for performance on 1,313 children under five years old by 207 frontline health workers between February and May 2015. Phone and handheld pulse oximeters had greater overall agreement with the reference standard (56%; 95% CI 0.52 - 0.60 to 68%; 95% CI 0.65 - 0.71) than the finger-tip POx (31%; 95% CI 0.26 to 0.36 and 47%; 95% CI 0.42 to 0.52). Fingertip POx performance was substantially lower in the 0-2 month olds; having just 17% and 25% agreement. The finger-tip devices more often underreported SpO2 readings (mean difference -7.9%; 95%CI -8.6,-7.2 and -3.9%; 95%CI -4.4,-3.4), and therefore over diagnosed hypoxaemia in the children assessed. INTERPRETATION While the Masimo phone pulse oximeter performed best, all handheld POx with age-specific probes performed well in the hands of frontline health workers, further highlighting their suitability as a screening tool of severe illness. The poor performance of the fingertip POx suggests they should not be used in children under five by frontline health workers. It is essential that POx are performance tested on children in routine settings (in vivo), not only in laboratories or controlled settings (in vitro), before being introduced at scale. FUNDING Bill & Melinda Gates Foundation [OPP1054367].
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Affiliation(s)
- Kevin Baker
- Malaria Consortium, London, United Kingdom
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Corresponding author at: Kevin Baker, Malaria Consortium, The Green House, 244-254 Cambridge Heath Road, London, E2 9DA
| | - Max Petzold
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- University of the Witwatersrand, Johannesburg, South Africa
| | | | | | | | | | | | | | | | | | | | | | | | | | - Tobias Alfvén
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Sachs’ Children and Youth Hospital, Stockholm, Sweden
| | - Karin Källander
- Malaria Consortium, London, United Kingdom
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Programme Division, Health Section, UNICEF, New York, United States
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12
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Dale NM, Parshuram C, Tomlinson G, Shepherd S, Mohammed Ashir G, Bukar LM, Zlotkin S. Performance of automated versus nurse-measured respiratory rate measurements in hospitalised malnourished children. Acta Paediatr 2021; 110:2249-2251. [PMID: 33527523 DOI: 10.1111/apa.15781] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Nancy M. Dale
- Centre for Global Child Health Hospital for Sick Children Toronto ON Canada
| | | | - George Tomlinson
- Department of Medicine University Health Network Toronto ON Canada
| | | | - Garba Mohammed Ashir
- Department of Pediatrics University of Maiduguri Teaching Hospital Maiduguri Nigeria
| | - Lawan Maryah Bukar
- Department of Pediatrics University of Maiduguri Teaching Hospital Maiduguri Nigeria
| | - Stanley Zlotkin
- Centre for Global Child Health Hospital for Sick Children Toronto ON Canada
- Department of Paediatrics Hospital for Sick Children Toronto ON Canada
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13
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Stratil AS, Ward C, Habte T, Maurel A, Antson M, Naydenova E, Baker K. Evaluating the Interrater Agreement and Acceptability of a New Reference Tool for Assessing Respiratory Rate in Children under Five with Cough and/or Difficulty Breathing. J Trop Pediatr 2021; 67:6297970. [PMID: 34124753 PMCID: PMC8201841 DOI: 10.1093/tropej/fmab046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Manual assessment of respiratory rate (RR) in children is unreliable, but remains the main method to diagnose pneumonia in low-resource settings. While automated RR counters offer a potential solution, there is currently no gold standard to validate these diagnostic aids. A video-based reference tool is proposed that allows users to annotate breaths and distortions including movement periods, allowing the exclusion of distortions from the computation of RR measures similar to how new diagnostic aids account for distortions automatically. This study evaluated the interrater agreement and acceptability of the new reference tool. METHODS Annotations were based on previously recorded reference videos of children under five years old with cough and/or difficulty breathing (n = 50). Five randomly selected medical experts from a panel of ten annotated each video. RR measures (breaths per minute, bpm) were computed as the number of annotated certain breaths divided by the length of calm periods after removing annotated distorted periods. RESULTS Reviewers showed good interrater agreement on continuous RR {standard error of measurement (SEM) [4.8 (95%CI 4.4-5.3)]} and substantial agreement on classification of fast breathing (Fleiss kappa, κ 0.71). Agreement was lowest in the youngest age group [< 2 months: SEM 6.2 (5.4-7.4) bpm, κ 0.48; 2-11 months: 4.7 (4.0-5.8) bpm, κ 0.84; 12-59 months: 2.6 (2.2-3.1) bpm, κ 0.8]. Reviewers found the functionalities of the tool helpful in annotating breaths, but remained uncertain about the validity of their annotations. CONCLUSIONS Before the new tool can be considered a reference standard for RR assessments, interrater agreement in children younger than 2 months must be improved.
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Affiliation(s)
- Ann-Sophie Stratil
- Malaria Consortium, E2 9DA, London, UK,Correspondence: Ann-Sophie Stratil, Malaria Consortium, The Green House, 244-254 Cambridge Heath Road, London, E2 9DA, UK. E-mail
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14
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Coleman J, Ginsburg AS, Macharia WM, Ochieng R, Zhou G, Dunsmuir D, Karlen W, Ansermino JM. Identification of thresholds for accuracy comparisons of heart rate and respiratory rate in neonates. Gates Open Res 2021; 5:93. [PMID: 34901754 PMCID: PMC8630397 DOI: 10.12688/gatesopenres.13237.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 04/05/2024] Open
Abstract
Background: Heart rate (HR) and respiratory rate (RR) can be challenging to measure accurately and reliably in neonates. The introduction of innovative, non-invasive measurement technologies suitable for resource-constrained settings is limited by the lack of appropriate clinical thresholds for accuracy comparison studies. Methods: We collected measurements of photoplethysmography-recorded HR and capnography-recorded exhaled carbon dioxide across multiple 60-second epochs (observations) in enrolled neonates admitted to the neonatal care unit at Aga Khan University Hospital in Nairobi, Kenya. Trained study nurses manually recorded HR, and the study team manually counted individual breaths from capnograms. For comparison, HR and RR also were measured using an automated signal detection algorithm. Clinical measurements were analyzed for repeatability. Results: A total of 297 epochs across 35 neonates were recorded. Manual HR showed a bias of -2.4 (-1.8%) and a spread between the 95% limits of agreement (LOA) of 40.3 (29.6%) compared to the algorithm-derived median HR. Manual RR showed a bias of -3.2 (-6.6%) and a spread between the 95% LOA of 17.9 (37.3%) compared to the algorithm-derived median RR, and a bias of -0.5 (1.1%) and a spread between the 95% LOA of 4.4 (9.1%) compared to the algorithm-derived RR count. Manual HR and RR showed repeatability of 0.6 (interquartile range (IQR) 0.5-0.7), and 0.7 (IQR 0.5-0.8), respectively. Conclusions: Appropriate clinical thresholds should be selected a priori when performing accuracy comparisons for HR and RR. Automated measurement technologies typically use median values rather than counts, which significantly impacts accuracy. A wider spread between the LOA, as much as 30%, should be considered to account for the observed physiological nuances and within- and between-neonate variability and different averaging methods. Wider adoption of thresholds by data standards organizations and technology developers and manufacturers will increase the robustness of clinical comparison studies.
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Affiliation(s)
- Jesse Coleman
- Evaluation of Technologies for Neonates in Africa (ETNA), Aga Khan University Hospital, Nairobi, Kenya
| | | | | | - Roseline Ochieng
- Department of Paediatrics, Aga Khan University Hospital, Nairobi, Kenya
| | - Guohai Zhou
- Center for Clinical Investigation, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Dustin Dunsmuir
- Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - Walter Karlen
- Mobile Health Systems Lab, Department of Health Sciences and Technology, ETH Zürich, Zürich, 8092, Switzerland
| | - J. Mark Ansermino
- Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
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15
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Carina K, Kevin B, Rebecca N, Bassat Q, Shamim Ahmad Q, Eric D. M. Back to Basics in Paediatric Pneumonia-Defining a Breath and Setting Reference Standards to Innovate Respiratory Rate Counting. J Trop Pediatr 2020; 67:6024861. [PMID: 33280051 PMCID: PMC7948383 DOI: 10.1093/tropej/fmaa112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- King Carina
- Department of Global Public Health, Karolinska Institutet, Sweden,Institute for Global Health, University College London, UK,Correspondence: Carina King, Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18B, 171 65 Solna, Sweden. E-mail <>
| | - Baker Kevin
- Department of Global Public Health, Karolinska Institutet, Sweden,Malaria Consortium, UK
| | - Nantanda Rebecca
- Makerere University Lung Institute, Makerere University College of Health Sciences, Uganda
| | - Quique Bassat
- ISGlobal, Hospital Clínic – Universitat de Barcelona, Barcelona, Spain,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique,ICREA, Pg. Lluís Companys 23, Barcelona 08010, Spain,Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Qazi Shamim Ahmad
- Consultant (Retired World Health Organisation Staff), Geneva, Switzerland
| | - McCollum Eric D.
- Global Program in Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, Johns Hopkins School of Medicine, USA,Department of International Health, Johns Hopkins Bloomberg School of Public Health, USA
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16
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Nicolò A, Massaroni C, Schena E, Sacchetti M. The Importance of Respiratory Rate Monitoring: From Healthcare to Sport and Exercise. SENSORS (BASEL, SWITZERLAND) 2020; 20:E6396. [PMID: 33182463 PMCID: PMC7665156 DOI: 10.3390/s20216396] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/05/2020] [Accepted: 11/08/2020] [Indexed: 12/11/2022]
Abstract
Respiratory rate is a fundamental vital sign that is sensitive to different pathological conditions (e.g., adverse cardiac events, pneumonia, and clinical deterioration) and stressors, including emotional stress, cognitive load, heat, cold, physical effort, and exercise-induced fatigue. The sensitivity of respiratory rate to these conditions is superior compared to that of most of the other vital signs, and the abundance of suitable technological solutions measuring respiratory rate has important implications for healthcare, occupational settings, and sport. However, respiratory rate is still too often not routinely monitored in these fields of use. This review presents a multidisciplinary approach to respiratory monitoring, with the aim to improve the development and efficacy of respiratory monitoring services. We have identified thirteen monitoring goals where the use of the respiratory rate is invaluable, and for each of them we have described suitable sensors and techniques to monitor respiratory rate in specific measurement scenarios. We have also provided a physiological rationale corroborating the importance of respiratory rate monitoring and an original multidisciplinary framework for the development of respiratory monitoring services. This review is expected to advance the field of respiratory monitoring and favor synergies between different disciplines to accomplish this goal.
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Affiliation(s)
- Andrea Nicolò
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy;
| | - Carlo Massaroni
- Unit of Measurements and Biomedical Instrumentation, Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy; (C.M.); (E.S.)
| | - Emiliano Schena
- Unit of Measurements and Biomedical Instrumentation, Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy; (C.M.); (E.S.)
| | - Massimo Sacchetti
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy;
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17
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Helldén D, Baker K, Habte T, Batisso E, Orsini N, Källander K, Alfvén T. Does Chest Attachment of an Automated Respiratory Rate Monitor Influence the Actual Respiratory Rate in Children Under Five? Am J Trop Med Hyg 2020; 102:20-27. [PMID: 31769406 PMCID: PMC6947785 DOI: 10.4269/ajtmh.19-0458] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 10/17/2019] [Indexed: 11/07/2022] Open
Abstract
Pneumonia is one of the leading causes of death in children under 5 years worldwide. In resource-limited settings, WHO recommendations state that pneumonia can be presumptively diagnosed through the presence of cough and/or difficult breathing and a respiratory rate (RR) that is higher than age-specific cutoffs. As a new diagnostic aid the children's automated respiration monitor (ChARM) can automatically measure and classify RR in children under 5 years, but the effect of its chest attachment on the RR has not been studied. The aim of this study was to understand if misclassification of the true RR occurred by ChARM attachment. Two hundred eighty-seven children at a health center in South Ethiopia were screened for eligibility, with 188 children aged 2-59 months enrolled in the study. The RR was measured manually before and 1, 3, and 5 minutes after ChARM attachment. The proportion of children with fast or normal RR classification at baseline and the change between RR classifications over time were analyzed. Eight (4.9%; 95% CI 2.1, 9.4) of 163 children changed RR classification from normal to fast between the baseline RR count and the 1 minute RR count. Results from this study suggest that ChARM has a minor influence on the RR of children immediately after attachment, in most cases without clinical importance.
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Affiliation(s)
- Daniel Helldén
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Kevin Baker
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Malaria Consortium, London, United Kingdom
| | | | | | - Nicola Orsini
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Karin Källander
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Malaria Consortium, London, United Kingdom
- UNICEF Health Section, New York, New York
| | - Tobias Alfvén
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Sachs’ Children and Youth Hospital, Stockholm, Sweden
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18
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Ansermino JM, Dunsmuir D, Karlen W, Gan H, Dumont GA. Are respiratory rate counters really so bad? Throwing the baby out with the bath water. EClinicalMedicine 2019; 16:14. [PMID: 31832612 PMCID: PMC6890939 DOI: 10.1016/j.eclinm.2019.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/23/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- J Mark Ansermino
- The University of British Columbia, British Columbia Children's Hospital Research Institute, V6H 3V4, Canada
- Corresponding author.
| | - Dustin Dunsmuir
- The University of British Columbia, British Columbia Children's Hospital Research Institute, V6H 3V4, Canada
| | - Walter Karlen
- ETH Zurich, Mobile Health Systems Lab, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, BAA, Lengghalde 5, 8092 Zurich, Switzerland
| | - Heng Gan
- Department of Anesthesia, British Columbia Children's Hospital, Vancouver BC V6H 3V4, Canada
| | - Guy A Dumont
- The University of British Columbia, British Columbia Children's Hospital Research Institute, V6H 3V4, Canada
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19
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Baker K, Alfvén T, Källander K. More work needs to be done to ensure that better pneumonia diagnostics aids are developed and launched to better support frontline health workers-A response to "Are respiratory rate counters really so bad" by Ansermino et al. EClinicalMedicine 2019; 16:15. [PMID: 31832613 PMCID: PMC6890940 DOI: 10.1016/j.eclinm.2019.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 09/23/2019] [Indexed: 11/21/2022] Open
Affiliation(s)
- Kevin Baker
- Malaria Consortium, The Green House, 224-254 Cambridge Heath Road, London E2 9DA, UK
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20
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Amirav I, Lavie M. Rethink Respiratory Rate for Diagnosing Childhood Pneumonia. EClinicalMedicine 2019; 12:6-7. [PMID: 31388657 PMCID: PMC6677654 DOI: 10.1016/j.eclinm.2019.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 06/20/2019] [Indexed: 12/02/2022] Open
Affiliation(s)
- Israel Amirav
- Pediatric Pulmonology Unit, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center, Israel
- Department of Pediatrics, University of Alberta, Edmonton, Canada
- Corresponding author at: Department of Pediatrics, University of Alberta, Edmonton, Canada.
| | - Moran Lavie
- Pediatric Pulmonology Unit, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center, Israel
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