Repeatability of RRate measurements in children during triage in two Ugandan hospitals

Bibliographic Data

ID19594980
AuthorsAhmad Asdo (0000-0001-7570-027X, University of British Columbia, corresponding author), Alishah Mawji (0000-0002-1591-947X, University of British Columbia, corresponding author), Isaac Omara (Gulu Hospital, corresponding author), Ivan Aine Aye Ishebukara (corresponding author), Clare Komugisha (0000-0002-9020-5346, corresponding author), Stefanie Novakowski (0000-0002-2715-091X, University of British Columbia, corresponding author), Yashodani Pillay (0000-0002-5814-7975, University of British Columbia, corresponding author), Matthew O Wiens (0000-0002-3287-5181, University of British Columbia, corresponding author), Samuel Akech (0000-0001-5126-1225, Kenya Medical Research Institute, corresponding author), Florence Oyella (Gulu Hospital, corresponding author), Abner Tagoola (Jinja Hospital, corresponding author), Niranjan Kissoon (0000-0001-8847-9973, University of British Columbia, corresponding author), J Mark Ansermino (0000-0001-8427-2035, University of British Columbia, corresponding author), Dustin Dunsmuir (0000-0001-9717-3685, University of British Columbia, corresponding author)
EditorsHannah Hogan Leslie
Year2025
Volume5
Issue1
Pagese0003097
Publication date2025-01-07
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenuePLOS Global Public Health (JOURNAL)
Journal identifiersISSN: 2767-3375 • E-ISSN: 2767-3375
PublisherPublic Library of Science (PLoS) (PUBLISHER)
DOI10.1371/journal.pgph.0003097
PMID39775211
OpenAlexW4406141918
LanguageEN
Citations received1
References cited15

Pneumonia is the leading cause of death in children globally. In low- and middle-income countries (LMICs) pneumonia diagnosis relies on accurate assessment of respiratory rate, which can be unreliable when completed by nurses with less-advanced training. To inform more accurate measurements, we investigate the repeatability of the RRate app used by nurses in Ugandan district hospitals. This secondary analysis included 3,679 children aged 0–5 years. The dataset had two sequential measurements of respiratory rate collected by 14 nurses using the RRate app. We measured agreement between respiratory rate observations while indicating observations’ clustering around WHO fast-breathing thresholds. WHO thresholds are 60 breaths per minute (bpm) for under two months (Age-1), 50 bpm for two to 12 months (Age-2), and 40 bpm for 12.1 to 60 months (Age-3). We assessed the repeatability of the paired measurements per user through the Intraclass Correlation Coefficient (ICC) and calculated an overall ICC value. The respiratory rate measurement took less than 15 seconds for 7,277 (98.9%) of the measurements. Despite respiratory rates clustering around WHO thresholds, breathing classification based on the thresholds (Fast vs normal) was altered between sequential measurements in only 12.6% of children. The mean (SD) respiratory rate by age group was 60 (13.1) bpm for Age-1, 49 (11.9) bpm for Age-2, and 38 (10.1) for Age-3, and the bias (Limits of Agreements) were 0.3 (−10.8–11.3) bpm, 0.4 (−8.5–9.3) bpm, and 0.1 (−6.8, 7.0) bpm for Age-1, Age-2, and Age-3 respectively. The repeatability of the paired respiratory rate measurements was high, with an ICC ≥ 90% for 12 of 14 users and an overall ICC value (95% CI) of 0.95 (0.94–0.95). The RRate measurements were efficient and repeatable. The simplicity, repeatability, and efficiency support its usage in LMICs healthcare facilities, and endorses a more widespread clinical adoption

Age groups · Blood pressure · Heart rate · Intraclass correlation · Pneumonia · Repeatability · Respiratory Rate · Respiratory system · Statistics · Triage · Demography · Emergency and Acute Care Studies · Mathematics · Medicine · Pneumonia and Respiratory Infections · Respiratory viral infections research · Emergency Medicine · Internal Medicine · Pediatrics