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Evaluating the performance of an automated respiratory rate counter in detecting fast breathing pneumonia in children
Ahad Mahmud Khan1,2, Md Shafiqul Islam1, Nabidul Haque Chowdhury1
1Projahnmo Research Foundation, Dhaka, Bangladesh.
Insights
An automated respiratory rate (RR) counter, ChARM, shows promise for diagnosing childhood pneumonia by accurately counting RR against a video expert panel (VEP). While effective for most cases, further research is needed for challenging clinical scenarios.
Area of Science:
- Pediatric respiratory health
- Medical device technology
- Diagnostic accuracy studies
Background:
- Childhood pneumonia diagnosis under Integrated Management of Childhood Illness (IMCI) guidelines relies on manual respiratory rate (RR) counting.
- Inaccurate RR counting by healthcare workers leads to misdiagnosis and adverse outcomes.
- Automated RR counters offer a potential solution to improve diagnostic accuracy.
Purpose of the Study:
- To evaluate the performance of an automated RR counter (ChARM) for diagnosing childhood pneumonia.
- To compare ChARM's RR counts against a reference standard established by a video expert panel (VEP).
Main Methods:
- A cross-sectional study was conducted with children aged 0-59 months presenting with suspected pneumonia in Bangladesh.
- ChARM was used to count RR, while chest movements were videotaped for simultaneous interpretation by a VEP.
- ChARM's accuracy was assessed against VEP consensus, and the time taken for RR counting was recorded.
Main Results:
- ChARM successfully counted RR in 86.7% of 339 children, with VEP consensus achieved in 87.4% of cases.
- ChARM and VEP agreed on RR counts within 2 bpm in 68.1% of children (mean difference: 1.7 bpm).
- ChARM demonstrated high sensitivity (95.8%) and specificity (93.5%) in classifying age-adjusted fast breathing, with strong agreement (kappa=0.86). Median counting time was 66 seconds.
Conclusions:
- The ChARM automated RR counter shows potential to support health workers in diagnosing childhood pneumonia due to its accuracy against a VEP reference.
- ChARM was unsuccessful in approximately 13% of cases, particularly those clinically complex, indicating potential systematic bias.
- Further research is necessary to address limitations and confirm ChARM's reliability for widespread clinical application.
Background:
According to the World Health Organization's Integrated Management of Childhood Illness (IMCI) guidelines, childhood pneumonia diagnosis relies on counting respiratory rate (RR). Counting RR by health workers is frequently inaccurate, leading to misdiagnosis and poor outcomes. Automated RR counters could potentially overcome these limitations. To address this gap, we introduced an automated RR counter and developed a reference video expert panel (VEP) to evaluate its performance.
Methods:
We conducted a cross-sectional study involving children aged 0-59 months with suspected pneumonia in Bangladesh. The RR of children was counted using an automated counter (ChARM) and chest movements were simultaneously videotaped. These videos were interpreted by the VEP, trained to a standard procedure. We assessed ChARM's accuracy in comparison to the RR generated by the VEP and summarised the time taken to count RR by ChARM.
Results:
Among 339 enrolled children, ChARM successfully counted the RR of 294 children (86.7%). The VEP reached a consensus (i.e., RR count difference within two breaths per minute (bpm) between two VEP members) in 257 of the 294 children (87.4%). ChARM and the VEP agreed on RR counts within two bpm in 68.1% of children (n = 175/257), with a mean difference of 1.7 bpm and limits of agreement ranging from -6.7 to 10.2 bpm. ChARM classified age-adjusted fast and normal breathing with a sensitivity of 95.8% (95% CI: 88.1-99.1) and a specificity of 93.5% (95% CI: 89.0-96.6), demonstrating high agreement (kappa = 0.86). The median time to count the RR by ChARM was 66 s (interquartile range: 61-73 s).
Conclusions:
ChARM counted RR accurately against a VEP reference, indicating a potential role in supporting health workers to diagnose pneumonia. However, it was unsuccessful for 1 in 8 cases, typically those more clinically challenging, suggesting a possible systematic bias. Further research is needed to address these issues and confirm ChARM's reliability for broader use in real-world settings.
Trial Registration:
Current Controlled Trials ISRCTN14120515, registered retrospectively on 19 September 2024.
Supplementary Information:
The online version contains supplementary material available at 10.1186/s44247-025-00175-3.
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