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Abstracts: Respiratory rate is an important vital sign used for diagnosing illnesses in children as well as prioritising patient care. All children presenting acutely to hospital should have a respiratory rate measured as part of their initial and ongoing assessment. However measuring the respiratory rate remains a subjective assessment and in children can be liable to measurement error especially if the child is uncooperative. Devices to measure respiratory rate exist but many provide only an estimate of respiratory rate due to the associated methodological complexities. Some devices are used within the intensive care, post-operative or more specialised investigatory settings none however have made their way into the everyday clinical setting. A non-contact device may be better tolerated in children and not cause undue stress distorting the measurement. Further validation and adaption to the acute clinical setting is needed before such devices can supersede current methods.

ObjectiveTo assess the value of respiratory rate (RR) as a predictor of clinical deterioration in children, compared with other vital sign measurements.DesignA retrospective case‐control study, comparing children who deteriorated, requiring admission to critical care with children who did not deteriorate.MethodsRR, heart rate (HR), and blood pressure (BP) measurements were collected from each patient for a 48‐hour duration. The 95th centile was identified for each and 5% to 30% thresholds above the 95th centile were calculated. For each threshold the sensitivity, specificity, odds ratio, positive, and negative predictive value for deterioration was calculated.ResultsForty cases (age range 7 weeks‐15 years) and 40 control patients matched for age, gender, and hospital location were recruited. In 30/40 patients who deteriorated at least one RR ≥ 30% above the 95th centile for their age was recorded in the 48 hours before deterioration, compared with 10/40 controls, regardless of clinical diagnosis. Only 3/40 children that deteriorated had a HR > 30% greater than the 95th centile, compared with 2/40 controls. An elevated RR was the only vital sign whose odds ratios were significant at each threshold level above the 95th centile. Maximum RR occurred 16.8 hours before deterioration.ConclusionRR is a more accurate predictor of clinical deterioration in children than other vital signs. Greater weighting and importance should be placed on RR, which is often omitted in children due to difficulties with its measurement.

ObjectiveTo determine the inter-observer agreement of a respiratory rate (RR) count on a child when assessed by three independent observers.DesignThe RR of 169 children (age range: 3 days to 15 years) was measured by three independent observers over a 3-month period. The first RR was taken by different healthcare professionals (HCPs) from within the hospital using their own preferred method of measurement. A further count of RR was then taken by two observers from the research team simultaneously within 30 min of the first measurement, using the WHO-recommended method of measurement.Results507 RR measurements were taken on 169 children. Median RR showed a 4 beats per minute (bpm) difference between the HCP (median RR 32 bpm) and the researchers (median RR 28 bpm). The 95% limits of agreement between the first measurement and second and third measurements were −10.2 to 17.7 bpm and −11.4 to 18.7 bpm, respectively. For simultaneous measurements, the 95% limits of agreement were −7.1 to 7.0 bpm. 81 children had a RR > 95th centile for their age and an even poorer level of agreement was seen in these children than in those whose RR was within normal range. In only 27 of these 81 children (33%) did all three observers agree on the presence of a raised RR.ConclusionsInter-observer agreement for the measurement of RR in children is poor. The effect that this variation has on the clinical assessment and subsequent management of a child may be significant. These findings highlight the need for a robust review of our current measurement methods and interpretation of an important vital sign.