Measurement of respiratory rate by multiple raters in a clinical setting is unreliable: A cross-sectional simulation study

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Objective:To evaluate the inter-observer reliability of nurses assessing respiratory rate.Methods:We presented seven minimum 60-seconds long videos of thoraces of non-identifiable patients breathing to experienced nurses from several Danish emergency departments. Two videos were assessed by 50 raters while five were reviewed by eight. The videos were shown using an online system that also recorded the counted respiratory rate.Results:A total of 140 nurses participated with a median of 15 years' experience. The range of counted respiratory rate was minimum 10 on each video. For videos evaluated by eight nurses, average Inter Class Coefficient (ICC) was 0.662 (0.000–0.960) and individual ICC 0.197 (0.000–0.750). For the two case-videos analyzed by 50 nurses, average ICC was 0.0 (0.000–0.991) and individual ICC 0.0 (0.000–0.677).Conclusions:We found a wide variation in measurements of RR with both few and many observers assessing exactly the same patients.HighlightsRespiratory rate is part of most risk stratification tools.Abnormal values are correlated to poor outcome.We found wide variation in measurements of respiratory rate.

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