Recorded respiratory rate in 36,966 hospitalizations was not normally distributed (p<0.001) but clustered at 18 and 20 breaths per minute, suggesting inaccurate 'spot' estimation.
Observational (n=36,966)
Yes
Is recorded respiratory rate accurately measured in hospitalized adults?
Recorded respiratory rates in hospitalized adults are frequently inaccurate and clustered around 18 and 20 breaths per minute, potentially jeopardizing patient safety by misclassifying disease severity.
p-value: p=<0.001
BACKGROUND: Respiratory rate (RR) is an independent predictor of adverse outcomes and an integral component of many risk prediction scores for hospitalised adults. Yet, it is unclear if RR is recorded accurately. We sought to assess the potential accuracy of RR by analysing the distribution and variation as a proxy, since RR should be normally distributed if recorded accurately. METHODS: We conducted a descriptive observational study of electronic health record data from consecutive hospitalisations from 2009 to 2010 from six diverse hospitals. We assessed the distribution of the maximum RR on admission, using heart rate (HR) as a comparison since this is objectively measured. We assessed RR patterns among selected subgroups expected to have greater physiological variation using the coefficient of variation (CV=SD/mean). RESULTS: Among 36 966 hospitalisations, recorded RR was not normally distributed (p<0.001), but right skewed (skewness=3.99) with values clustered at 18 and 20 (kurtosis=23.9). In contrast, HR was relatively normally distributed. Patients with a cardiopulmonary diagnosis or hypoxia only had modestly greater variation (CV increase of 2%-6%). Among 1318 patients transferred from the ward to the intensive care unit (n=1318), RR variation the day preceding transfer was similar to that observed on admission (CV 0.24 vs 0.26), even for those transferred with respiratory failure (CV 0.25). CONCLUSIONS: The observed patterns suggest that RR is inaccurately recorded, even among those with cardiopulmonary compromise, and represents a 'spot' estimate with values of 18 and 20 breaths per minute representing 'normal.' While spot estimates may potentially be adequate to indicate clinical stability, inaccurate RR may alternatively lead to misclassification of disease severity, potentially jeopardising patient safety. Thus, we recommend greater training for hospital personnel to accurately record RR.
Badawy et al. (Mon,) conducted a observational in Hospitalised adults (n=36,966). Recorded respiratory rate vs. Heart rate was evaluated on Distribution of the maximum respiratory rate on admission (p=<0.001). Recorded respiratory rate in 36,966 hospitalizations was not normally distributed (p<0.001) but clustered at 18 and 20 breaths per minute, suggesting inaccurate 'spot' estimation.