Respiratory rate is an early predictor of clinical deterioration in children

Abstract

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.

Proposed Assessment of Cough and Dyspnea in Children via Telemedicine in Coronavirus Disease 2019 Era: A Web Application—HOPS

“…14 On the other hand, the respiratory rate is an early predictor of deterioration in hospitalized children. 15 The measurement of the respiratory rate and the oxygen saturation level can be quite challenging for the parents. We must rely on parental competency, but the guidance of the consulting physician could optimize that process.…”

Respiration Measurement in a Simulated Setting Incorporating the Internet of Things

“…It is around 15 bpm in healthy adults, and it is higher in young healthy children. RR is an important indicator of deterioration in critically ill patients and its monitoring is therefore clinically crucial [38].…”

Health professionals’ initial experiences and perceptions of the acceptability of a whole-hospital, pro-active electronic paediatric early warning system (the DETECT study): a qualitative interview study

“…Paediatric early warning systems (PEWS) [ 1 – 3 ] and PEW scores [ 4 – 6 ] are based on a child’s vital signs and other factors such as parental concern [ 7 , 8 ]. They alert health professionals (HPs) to signs of a child’s deterioration, with the intention of triggering an urgent review and escalating care, as needed [ 9 ], and reducing emergency transfer to critical care, cardiac arrest and death [ 10 – 14 ]. Recording PEW scores can be paper-based or electronic [ 3 , 9 , 15 ]; e-scoring has advantages in comparison to paper-based scoring in terms of enhanced safety benefits including greater time efficiency, reduction in human error and instant availability of the recorded data [ 16 , 17 ].…”