TY - JOUR
T1 - Revitalizing a vital sign
T2 - Improving detection of tachypnea at primary triage
AU - Bianchi, William
AU - Dugas, Andrea Freyer
AU - Hsieh, Yu Hsiang
AU - Saheed, Mustapha
AU - Hill, Peter
AU - Lindauer, Cathleen
AU - Terzis, Andreas
AU - Rothman, Richard E.
N1 - Funding Information:
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org ). The authors have stated that no such relationships exist. Funded by National Science Foundation grant CNS-0855191 .
PY - 2013/1
Y1 - 2013/1
N2 - Study objective: This study evaluates the accuracy of emergency department (ED) triage respiratory rate measurement using the usual care method and a new electronic respiratory rate sensor (BioHarness, Zephyr Technology Corp.), both compared to a criterion standard measurement. Methods: This is a cross-sectional study with convenience sampling conducted in an urban academic adult ED, including 3 separate respiratory rate measurements performed at ED triage: usual care measurement, electronic BioHarness measurement, and criterion standard measurement. The criterion standard measurement used was defined by the World Health Organization as manual observation or auscultation of respirations for 60 seconds. The resultant usual care and BioHarness measurements were compared with the criterion standard, evaluating accuracy (sensitivity and specificity) for detecting tachypnea, as well as potential systematic biases of usual care and BioHarness measurements using a Bland Altman analysis. Results: Of 191 analyzed patients, 44 presented with tachypnea (>20 breaths/min). Relative to criterion standard measurement, usual care measurement had a sensitivity of 23% (95% confidence interval [CI] 12% to 37%) and specificity of 99% (95% CI 97% to 100%) for tachypnea, whereas BioHarness had a sensitivity of 91% (95% CI 80% to 97%) and specificity of 97% (95% CI 93% to 99%) for tachypnea. Usual care measurements clustered around respiratory rates of 16 and 18 breaths/min (n=144), with poor agreement with criterion standard measurement. Conversely, BioHarness measurement closely tracked criterion standard values over the range of respiratory rates. Conclusion: Current methods of respiratory rate measurement at ED triage are inaccurate. A new electronic respiratory rate sensor, BioHarness, has significantly greater sensitivity for detecting tachypnea versus usual care method of measurement.
AB - Study objective: This study evaluates the accuracy of emergency department (ED) triage respiratory rate measurement using the usual care method and a new electronic respiratory rate sensor (BioHarness, Zephyr Technology Corp.), both compared to a criterion standard measurement. Methods: This is a cross-sectional study with convenience sampling conducted in an urban academic adult ED, including 3 separate respiratory rate measurements performed at ED triage: usual care measurement, electronic BioHarness measurement, and criterion standard measurement. The criterion standard measurement used was defined by the World Health Organization as manual observation or auscultation of respirations for 60 seconds. The resultant usual care and BioHarness measurements were compared with the criterion standard, evaluating accuracy (sensitivity and specificity) for detecting tachypnea, as well as potential systematic biases of usual care and BioHarness measurements using a Bland Altman analysis. Results: Of 191 analyzed patients, 44 presented with tachypnea (>20 breaths/min). Relative to criterion standard measurement, usual care measurement had a sensitivity of 23% (95% confidence interval [CI] 12% to 37%) and specificity of 99% (95% CI 97% to 100%) for tachypnea, whereas BioHarness had a sensitivity of 91% (95% CI 80% to 97%) and specificity of 97% (95% CI 93% to 99%) for tachypnea. Usual care measurements clustered around respiratory rates of 16 and 18 breaths/min (n=144), with poor agreement with criterion standard measurement. Conversely, BioHarness measurement closely tracked criterion standard values over the range of respiratory rates. Conclusion: Current methods of respiratory rate measurement at ED triage are inaccurate. A new electronic respiratory rate sensor, BioHarness, has significantly greater sensitivity for detecting tachypnea versus usual care method of measurement.
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U2 - 10.1016/j.annemergmed.2012.05.030
DO - 10.1016/j.annemergmed.2012.05.030
M3 - Article
C2 - 22738682
AN - SCOPUS:84871294665
SN - 0196-0644
VL - 61
SP - 37
EP - 43
JO - Annals of emergency medicine
JF - Annals of emergency medicine
IS - 1
ER -