Is everyone really breathing 20 times a minute? Assessing epidemiology and variation in recorded respiratory rate in hospitalised adults

Jack Badawy, Oanh Kieu Nguyen, Christopher Clark, Ethan A. Halm, Anil N. Makam

Producción científica: Articlerevisión exhaustiva

72 Citas (Scopus)

Resumen

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.

Idioma originalEnglish (US)
Páginas (desde-hasta)832-836
Número de páginas5
PublicaciónBMJ Quality and Safety
Volumen26
N.º10
DOI
EstadoPublished - oct 2017
Publicado de forma externa

ASJC Scopus subject areas

  • Health Policy

Huella

Profundice en los temas de investigación de 'Is everyone really breathing 20 times a minute? Assessing epidemiology and variation in recorded respiratory rate in hospitalised adults'. En conjunto forman una huella única.

Citar esto