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

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

• We might have been prescribing antibiotics to clients who do not need them”

  Open Access•Emily J Ciccone, Alfonso Zubizarreta Gutiérrez et al.•BMC Public Health•2025

  Incluir item

• Global burden of childhood pneumonia and diarrhoea

  Open Access•Christa L Fischer Walker, Igor Rudan et al.•The Lancet•2013

  Incluir item

• A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research

  Open Access•Terry K Koo, Mae Y Li•Journal of Chiropractic Medicine•2016

  Incluir item