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Evaluating the Interrater Agreement and Acceptability of a New Reference Tool for Assessing Respiratory Rate in Children under Five with Cough and/or Difficulty Breathing
Journal of Tropical Pediatrics ( IF 2 ) Pub Date : 2021-05-14 , DOI: 10.1093/tropej/fmab046
Ann-Sophie Stratil 1 , Charlotte Ward 1 , Tedila Habte 1 , Alice Maurel 1 , Max Antson 2 , Elina Naydenova 2 , Kevin Baker 1
Affiliation  

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.

中文翻译:

评估用于评估 5 岁以下咳嗽和/或呼吸困难儿童呼吸频率的新参考工具的评估者间一致性和可接受性

背景 手动评估儿童呼吸频率 (RR) 不可靠,但仍是资源匮乏地区诊断肺炎的主要方法。虽然自动 RR 计数器提供了一种潜在的解决方案,但目前还没有验证这些诊断辅助工具的黄金标准。提出了一种基于视频的参考工具,允许用户注释呼吸和扭曲,包括运动周期,允许从 RR 测量的计算中排除扭曲,类似于新的诊断辅助工具如何自动解释扭曲。这项研究评估了新参考工具的评价者协议和可接受性。方法注释基于先前录制的 5 岁以下儿童咳嗽和/或呼吸困难(n = 50)的参考视频。从十人小组中随机选择五名医学专家对每个视频进行注释。RR 测量值(每分钟呼吸次数,bpm)计算为带注释的某些呼吸的数量除以去除带注释的扭曲周期后的平静期长度。结果 审稿人对连续 RR {标准测量误差 (SEM) [4.8 (95%CI 4.4–5.3)]} 和快速呼吸的分类(Fleiss kappa, κ 0.71)显示出良好的评估者一致性。最小年龄组的一致性最低 [< 2 个月:SEM 6.2 (5.4–7.4) bpm,κ 0.48;2-11 个月:4.7 (4.0-5.8) bpm,κ 0.84;12-59 个月:2.6 (2.2-3.1) bpm,κ 0.8]。审稿人发现该工具的功能有助于注释呼吸,但仍不确定其注释的有效性。
更新日期:2021-05-14
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