Abstract
BackgroundManual 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.MethodsAnnotations 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.ResultsReviewers 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.ConclusionsBefore the new tool can be considered a reference standard for RR assessments, interrater agreement in children younger than 2 months must be improved.
Highlights
Pneumonia is the leading infectious cause of death in children accounting for 15% of all deaths of children under five years old in 2017 [1]
According to the World Health Organizations (WHO) guideline for the Integrated Management of Childhood Illnesses (IMCI), primary diagnostic criteria for pneumonia are the presence of cough or difficulty breathing and a raised respiratory rate (RR) in dependence of a child’s age
New, automated RR counters offer a potential solution by accounting for movement periods automatically or deriving RR through indirect methods not influenced by movement, thereby supporting the accurate assessment of RR under real-life circumstances [6, 7]
Summary
Pneumonia is the leading infectious cause of death in children accounting for 15% of all deaths of children under five years old in 2017 [1]. New, automated RR counters offer a potential solution by accounting for movement periods automatically or deriving RR through indirect methods not influenced by movement, thereby supporting the accurate assessment of RR under real-life circumstances [6, 7]. To introduce these new diagnostic aids at scale, their accuracy and reliability must first be validated against a robust reference standard. 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. 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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