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Developing a video expert panel as a reference standard to evaluate respiratory rate counting in paediatric pneumonia
Ahad Mahmud Khan1,2, Salahuddin Ahmed3,2, Nabidul Haque Chowdhury2
1Usher Institute, The University of Edinburgh, Edinburgh, UK ahad_mahmud@hotmail.com.
Insights
Accurate respiratory rate counting in children is crucial for diagnosing pneumonia. This study develops a video expert panel (VEP) to create a reliable standard for evaluating automated respiratory rate counting devices.
Area of Science:
- Pediatrics
- Medical Devices
- Diagnostic Accuracy
Background:
- Manual respiratory rate (RR) counting in children is prone to errors, potentially leading to pneumonia misdiagnosis.
- Automated RR counting devices offer a potential solution, but lack a validated reference standard for performance evaluation.
- Establishing a robust reference standard is essential for assessing the reliability of novel RR counting technologies.
Purpose of the Study:
- To develop a Video Expert Panel (VEP) as a reference standard for evaluating automated respiratory rate (RR) counting devices.
- To assess the performance of automated RR counters in identifying fast breathing in children.
- To improve the accuracy of pneumonia diagnosis in pediatric patients through reliable RR measurement.
Main Methods:
- A cross-sectional study enrolling children aged 0-59 months with suspected pneumonia in Bangladesh.
- Video recording of manual and automated RR counting (Children's Automated Respiration Monitor) for each child.
- Development and standardization of a VEP using high-quality reference videos to systematically interpret RR from recordings.
Main Results:
- The study aims to establish the VEP's reliability by assessing inter-rater agreement among panel members.
- Performance evaluation will involve calculating mean differences and agreement proportions (±2 breaths/min) using Bland-Altman plots.
- This methodology will provide quantitative data on the accuracy of automated RR counting compared to the VEP standard.
Conclusions:
- The developed VEP is expected to serve as a reliable reference standard for evaluating automated RR counting devices.
- This initiative will contribute to the validation of new technologies for accurate pneumonia diagnosis in children.
- Improved RR assessment through validated devices can enhance clinical decision-making and patient outcomes.
Introduction:
Manual counting of respiratory rate (RR) in children is challenging for health workers and can result in misdiagnosis of pneumonia. Some novel RR counting devices automate the counting of RR and classification of fast breathing. The absence of an appropriate reference standard to evaluate the performance of these devices is a challenge. If good quality videos could be captured, with RR interpretation from these videos systematically conducted by an expert panel, it could act as a reference standard. This study is designed to develop a video expert panel (VEP) as a reference standard to evaluate RR counting for identifying pneumonia in children.
Methods And Analysis:
Using a cross-sectional design, we will enrol children aged 0-59 months presenting with suspected pneumonia at different levels of health facilities in Dhaka and Sylhet, Bangladesh. We will videorecord a physician/health worker counting RR manually and also using an automated RR counter (Children's Automated Respiration Monitor) from each child. We will establish a standard operating procedure for capturing quality videos, make a set of reference videos, and train and standardise the VEP members using the reference videos. After that, we will assess the performance of the VEP as a reference standard to evaluate RR counting. We will calculate the mean difference and proportions of agreement within±2 breaths per minute and create Bland-Altman plots with limits of agreement between VEP members.
Ethics And Dissemination:
The study protocol was approved by the National Research Ethics Committee of Bangladesh Medical Research Council, Bangladesh (registration number: 39315022021) and Edinburgh Medical School Research Ethics Committee (EMREC), Edinburgh, UK (REC Reference: 21-EMREC-040). Dissemination of the study findings will be through conference presentations and publications in peer-reviewed scientific journals.
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