Inter-Observer Agreement in Measuring Respiratory Rate

Area of Science:

• Medical Sciences
• Nursing Practice
• Clinical Assessment

Background:

• Respiratory rate (RR) is a critical vital sign linked to in-hospital mortality.
• RR is frequently omitted during patient assessment due to measurement difficulties and potential for bias.
• Inter-observer reliability in RR measurement is crucial for accurate clinical evaluation.

Purpose of the Study:

• To compare the agreement between nursing staff counting manual respiratory rate (RR) and those using a predefined ordinal scale.
• To assess the inter-observer reliability of two distinct methods for measuring respiratory rate in a clinical setting.

Main Methods:

• A prospective study involving five videos of a man breathing at different rates (5, 10, 15, 30, 60 breaths/min).
• Nursing staff were randomized into two groups: one counting exact breaths per minute, the other using a predefined ordinal scale.
• Videos were presented in random order to participants for RR assessment.

Main Results:

• High inter-observer agreement was found when comparing the exact manual count of breaths per minute (Intra Class Coefficient = 0.99).
• Substantial agreement was observed when using the predefined ordinal scale (Kappa Fleiss Coefficient = 0.75).

Conclusions:

• Manual counting of respiratory rate by nursing staff demonstrates high inter-observer agreement.
• A predefined ordinal scale offers substantial inter-observer agreement for respiratory rate assessment.
• This study, the largest of its kind on RR inter-observer agreement, suggests further research into scaled comparisons is warranted.