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Evaluating the Interrater Agreement and Acceptability of a New Reference Tool for Assessing Respiratory Rate in
Ann-Sophie Stratil1, Charlotte Ward1, Tedila Habte1
1Malaria Consortium, E2 9DA, London, UK.
Insights
Manual respiratory rate (RR) assessment in children is unreliable. A new video tool for RR measurement shows promise but needs improvement in infants under two months for use as a diagnostic standard.
Area of Science:
- Pediatric diagnostics
- Medical technology innovation
- Respiratory health assessment
Background:
- Manual respiratory rate (RR) assessment is crucial for diagnosing childhood pneumonia in resource-limited settings but is often unreliable.
- Automated RR counters are emerging but lack a validated gold standard for accuracy.
- A novel video-based reference tool allows manual annotation of breaths and distortions to improve RR measurement accuracy.
Purpose of the Study:
- To evaluate the interrater agreement and acceptability of a new video-based reference tool for respiratory rate (RR) measurement in children.
- To assess the tool's potential as a gold standard for validating automated RR diagnostic aids.
- To identify areas for improvement in the tool's application, particularly in younger age groups.
Main Methods:
- Experts annotated reference videos of 50 children under five with respiratory symptoms.
- Respiratory rate (RR) was calculated by dividing annotated breaths by the duration of non-distorted periods.
- Interrater agreement was assessed using standard error of measurement (SEM) for continuous RR and Fleiss kappa (κ) for fast breathing classification.
Main Results:
- Good interrater agreement was observed for continuous RR (SEM 4.8 bpm) and substantial agreement for fast breathing classification (κ 0.71).
- Agreement varied significantly by age group, with the lowest agreement in infants under two months (SEM 6.2 bpm, κ 0.48).
- While reviewers found the tool helpful, they expressed uncertainty regarding the validity of their annotations.
Conclusions:
- The video-based reference tool demonstrates potential for improving RR assessment accuracy.
- Further refinement is necessary to enhance interrater agreement, especially in neonates (< 2 months), before it can serve as a reliable reference standard.
- Improved agreement in younger infants is critical for the tool's widespread adoption in clinical and research settings.
Background:
Manual assessment of respiratory rate (RR) in children is unreliable, but remains the main method to diagnose pneumonia in low-resource settings. While automated RR counters offer a potential solution, there is currently no gold standard to validate these diagnostic aids. A video-based reference tool is proposed that allows users to annotate breaths and distortions including movement periods, allowing the exclusion of distortions from the computation of RR measures similar to how new diagnostic aids account for distortions automatically. This study evaluated the interrater agreement and acceptability of the new reference tool.
Methods:
Annotations were based on previously recorded reference videos of children under five years old with cough and/or difficulty breathing (n = 50). Five randomly selected medical experts from a panel of ten annotated each video. RR measures (breaths per minute, bpm) were computed as the number of annotated certain breaths divided by the length of calm periods after removing annotated distorted periods.
Results:
Reviewers showed good interrater agreement on continuous RR {standard error of measurement (SEM) [4.8 (95%CI 4.4-5.3)]} and substantial agreement on classification of fast breathing (Fleiss kappa, κ 0.71). Agreement was lowest in the youngest age group [< 2 months: SEM 6.2 (5.4-7.4) bpm, κ 0.48; 2-11 months: 4.7 (4.0-5.8) bpm, κ 0.84; 12-59 months: 2.6 (2.2-3.1) bpm, κ 0.8]. Reviewers found the functionalities of the tool helpful in annotating breaths, but remained uncertain about the validity of their annotations.
Conclusions:
Before the new tool can be considered a reference standard for RR assessments, interrater agreement in children younger than 2 months must be improved.
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