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Determining the Agreement Between an Automated Respiratory Rate Counter and a Reference Standard for Detecting
Charlotte Ward1, Kevin Baker1,2, Sarah Marks1
1Malaria Consortium, London, United Kingdom.
Insights
Automated Respiratory Infection Diagnostic Aid (ARIDA) shows promise in accurately counting respiratory rates in young children, potentially improving pneumonia diagnosis. Further research is needed to establish a universal standard for automated counters.
Area of Science:
- Pediatric infectious diseases
- Medical device technology
- Diagnostic accuracy studies
Background:
- Acute respiratory infections (ARIs) are the leading infectious cause of mortality in children under five globally.
- Manual respiratory rate (RR) counting for pneumonia detection is challenging and prone to errors.
- Automated RR counters offer a potential solution to improve diagnostic accuracy.
Purpose of the Study:
- To evaluate the agreement between an Automated Respiratory Infection Diagnostic Aid (ARIDA) and expert clinicians using a video reference standard for RR counting.
- To assess the consistency and variability of ARIDA RR counts.
- To compare ARIDA performance with manual RR counting by expert clinicians.
Main Methods:
- A cross-sectional study enrolled 290 children aged 0-59 months in Addis Ababa, Ethiopia.
- Evaluated ARIDA agreement with a reference standard (expert panel video review).
- Assessed ARIDA device consistency and RR fluctuation over time; compared expert clinician manual counts.
Main Results:
- Primary outcomes focused on mean differences in RR counts between ARIDA and the reference standard (agreement) and between two ARIDA devices (consistency).
- The study design allowed for direct comparison of ARIDA and expert clinician performance against the reference standard.
Conclusions:
- While ARIDA shows potential, limitations include potential timing differences in breath counting and inherent human error in manual methods.
- Further research is required to establish a global consensus on the optimal reference standard and acceptable agreement levels for automated RR counters.
- Evidence is needed to guide ministries of health in deciding on the scalability of automated RR counting technology.
Background:
Acute respiratory infections (ARIs), primarily pneumonia, are the leading infectious cause of under-5 mortality worldwide. Manually counting respiratory rate (RR) for 60 seconds using an ARI timer is commonly practiced by community health workers to detect fast breathing, an important sign of pneumonia. However, correctly counting breaths manually and classifying the RR is challenging, often leading to inappropriate treatment. A potential solution is to introduce RR counters, which count and classify RR automatically.
Objective:
This study aims to determine how the RR count of an Automated Respiratory Infection Diagnostic Aid (ARIDA) agrees with the count of an expert panel of pediatricians counting RR by reviewing a video of the child's chest for 60 seconds (reference standard), for children aged younger than 5 years with cough and/or difficult breathing.
Methods:
A cross-sectional study aiming to enroll 290 children aged 0 to 59 months presenting to pediatric in- and outpatient departments at a teaching hospital in Addis Ababa, Ethiopia, was conducted. Enrollment occurred between April and May 2017. Once enrolled, children participated in at least one of three types of RR evaluations: (1) agreement-measure the RR count of an ARIDA in comparison with the reference standard, (2) consistency-measure the agreement between two ARIDA devices strapped to one child, and (3) RR fluctuation-measure RR count variability over time after ARIDA attachment as measured by a manual count. The agreement and consistency of expert clinicians (ECs) counting RR for the same child with the Mark 2 ARI timer for 60 seconds was also measured in comparison with the reference standard.
Results:
Primary outcomes were (1) mean difference between the ARIDA and reference standard RR count (agreement) and (2) mean difference between RR counts obtained by two ARIDA devices started simultaneously (consistency).
Conclusions:
Study strengths included the design allowing for comparison between both ARIDA and the EC with the reference standard RR count. A limitation is that exactly the same set of breaths were not compared between ARIDA and the reference standard since ARIDA can take longer than 60 seconds to count RR. Also, manual RR counting, even when aided by a video of the child's chest movements, is subject to human error and can result in low interrater reliability. Further work is needed to reach global consensus on the most appropriate reference standard and an acceptable level of agreement to provide ministries of health with evidence to make an informed decision on whether to scale up new automated RR counters.
Trial Registration:
ClinicalTrials.gov NCT03067558; https://clinicaltrials.gov/ct2/show/NCT03067558.
International Registered Report Identifier (Irrid):
RR1-10.2196/16531.
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