Accuracy of Hospital Monitor Respiratory Rates Compared to Manual Counts in Children

Purpose: Respiratory rates are an important vital sign for the hospitalized patient and are often counted by monitors. We assessed the accuracy of monitor readings when compared to manual counts stratified by patient age and diagnosis. Design and Methods: Hospitalized children aged 0 to 17 years placed on monitors were eligible. Respiratory rates were stratified by age and diagnosis-respiratory versus non-respiratory. Monitor respiratory rates were recorded every 3 seconds for duration of one minute. Concurrent manual counts were performed at 5, 10, 15, 30, and 60 seconds. Bland-Altman method was used to assess agreement between manual 60 second counts and the monitored respiratory rate. Results: Enrollment included 181 patients of which the majority (n = 93, 51%), were less than age 12 months, and 114 (63%) had non-respiratory diagnoses. The mean difference of the following interval manual counts compared to 60-second manual counts were +4.3 (overestimation) breaths with 6-second measurements, +3 breaths for 10 seconds, +1.6 breaths for 15 seconds, +1.3 breaths for 20 seconds, and +0.6 breaths for 30-second measurements. The mean difference of hospital monitors was -7.2 (underestimation) breaths. Monitor counts had increasing underestimation with increasing respiratory rates. There was significant underestimation of monitor respiratory rates compared to 60-second manual counts in infants less than age 6 months. There was no significant difference between respiratory and non-respiratory diagnoses. Conelusion: Hospital monitors underestimate respiratory rates compared to manual counts. Applieation to Praetiee: Clinicians should exercise caution in using monitor-generated respiratory rates to assess patient status, particularly in infants and those expected to have high respiratory rates. We found under-estimation of respiratory rates in these patients, which may lead to falsely low clinical screening and severity scores. Key Words: Hospital monitors, respiratory rates, manual counts, hospital pediatrics.
Respiratory rates are an essential vital sign in hospitalized children. Common reasons for pediatric hospitalizations, such as bronchiolitis, pneumonia, and sepsis, require accurate assessments of respiratory rates, and many pediatric [...]