Does Chest Attachment of an Automated Respiratory Rate Monitor Influence the Actual Respiratory Rate in Children Under Five?

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.

An openly available wearable, a diaper cover, monitors infant's respiration and position during rest and sleep

“…According to international guidelines of respiratory infection management, the RR levels are considered to vary in the order of tens of breaths per minute between normal and pathologically fast breathing, 1,10,24 which indicates that NAPPA's accuracy is clearly within the required limits. Substantial differences in individual RR levels are due to many more physiological factors, such as age, 1 altitude, 25 vigilance state, 16,26 position 27 or other acute medical conditions.…”

“…22 Development of NAPPA into such diagnostic aid of respiratory infections would require more future studies in comparable settings. 24 Alternatively, NAPPA wearable maybe used as is in academic clinical research for long-term measuring of respiration, activity and position.…”

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

“…Therefore, UNICEF launched the acute respiratory infection diagnostic aid (ARIDA) project and determined the target product profile of an automated RR counter [13]. Recently, two automated RR counters, i.e., a photoplethysmography-based (Masimo Rad G) [14][15][16] and accelerometer-based (Philips ChARM) [17][18][19][20] device have been evaluated in a low-resource setting. These studies revealed variable accuracy and some usability issues, such as slow performance and measurement failure [14][15][16][17][18][19][20].…”

“…Recently, two automated RR counters, i.e., a photoplethysmography-based (Masimo Rad G) [14][15][16] and accelerometer-based (Philips ChARM) [17][18][19][20] device have been evaluated in a low-resource setting. These studies revealed variable accuracy and some usability issues, such as slow performance and measurement failure [14][15][16][17][18][19][20]. However, for a full evaluation of the value of these two methods to detect fast breathing as a clinical danger sign, field studies should specifically address children with severe febrile illness in a low resource setting.…”

Usability and acceptability of an automated respiratory rate counter to assess childhood pneumonia in Nepal

“…The low adherence of Nepalese FCHVs to the WHO case management guidelines was primarily a result of a failure to ensure that the child was calm before and during the assessment. A previous study has shown that there is a small risk that ChARM attachment creates fluctuations in the child's RR that lead to misclassification25 ; hence, it is worth further exploring if ChARM device attachment effects children's behaviour and causes them to cry during the assessment. Other contextual factors, such as the low level of literacy, numeracy and training among FCHVs, as well as the remote location of the study where children were not used to strangers and FCHVs saw relatively few children during routine practice: just over five children in 76 days on average.…”