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Published on: February 9, 2022
Respiratory rate is an early predictor of clinical deterioration in children
William Daw1, Rena Kaur1, Mollie Delaney1
1Department of Respiratory Medicine, Academic Unit of Child Health, Sheffield Children's Hospital NHS Foundation Trust, Western Bank, Sheffield, UK.
Insights
Respiratory rate (RR) is a better predictor of clinical deterioration in children than heart rate or blood pressure. Monitoring RR is crucial for early detection of critical illness in pediatric patients.
Area of Science:
- Pediatric critical care medicine
- Clinical physiology
- Biostatistics
Background:
- Early detection of clinical deterioration in children is vital for timely intervention.
- Current vital sign monitoring may not adequately predict adverse events in pediatric patients.
- Respiratory rate (RR) is an important but often underutilized vital sign in pediatric assessment.
Purpose of the Study:
- To evaluate the predictive value of respiratory rate (RR) for clinical deterioration in children.
- To compare the efficacy of RR as a predictor against other vital signs like heart rate (HR) and blood pressure (BP).
Main Methods:
- A retrospective case-control study design was employed.
- Data from 40 deteriorating children and 40 matched controls were analyzed.
- Respiratory rate, heart rate, and blood pressure were measured over 48 hours, with analysis of thresholds above the 95th percentile.
Main Results:
- An elevated RR (≥30% above the 95th percentile) was significantly more frequent in deteriorating children (30/40) compared to controls (10/40).
- Elevated RR demonstrated significant odds ratios at multiple threshold levels, unlike HR or BP.
- The maximum RR indicative of deterioration occurred approximately 16.8 hours prior to the event.
Conclusions:
- Respiratory rate is a more accurate predictor of clinical deterioration in children than other commonly monitored vital signs.
- Increased emphasis on RR measurement and interpretation is recommended for pediatric patient monitoring.
- Addressing challenges in RR measurement in children could improve early detection of critical illness.
Objective:
To assess the value of respiratory rate (RR) as a predictor of clinical deterioration in children, compared with other vital sign measurements.
Design:
A retrospective case-control study, comparing children who deteriorated, requiring admission to critical care with children who did not deteriorate.
Methods:
RR, heart rate (HR), and blood pressure (BP) measurements were collected from each patient for a 48-hour duration. The 95th centile was identified for each and 5% to 30% thresholds above the 95th centile were calculated. For each threshold the sensitivity, specificity, odds ratio, positive, and negative predictive value for deterioration was calculated.
Results:
Forty cases (age range 7 weeks-15 years) and 40 control patients matched for age, gender, and hospital location were recruited. In 30/40 patients who deteriorated at least one RR ≥ 30% above the 95th centile for their age was recorded in the 48 hours before deterioration, compared with 10/40 controls, regardless of clinical diagnosis. Only 3/40 children that deteriorated had a HR > 30% greater than the 95th centile, compared with 2/40 controls. An elevated RR was the only vital sign whose odds ratios were significant at each threshold level above the 95th centile. Maximum RR occurred 16.8 hours before deterioration.
Conclusion:
RR is a more accurate predictor of clinical deterioration in children than other vital signs. Greater weighting and importance should be placed on RR, which is often omitted in children due to difficulties with its measurement.
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