Annals of Emergency Medicine
Volume 45, Issue 1 , Pages 68-76 , January 2005

The vexatious vital: Neither clinical measurements by nurses nor an electronic monitor provides accurate measurements of respiratory rate in triage

Received 22 December 2003 ,Revised 15 June 2004 ,Accepted 18 June 2004.

References 

  1. Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997;336:243–250
  2. Egermayer P, Town GI, Turner JG, et al. Usefulness of d-dimer, blood gas, and respiratory rate measurements for excluding pulmonary embolism. Thorax. 1998;53:830–834
  3. Stein PD, Terrin ML, Hales CA, et al. Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. Chest. 1991;100:598–603
  4. Christenson J, Etherington J, Grafstein E, et al. Early discharge of patients with presumed opioid overdose: development of a clinical prediction rule. Acad Emerg Med. 2001;7:1110–1118
  5. Galle C, Papazyan JP, Miron MJ, et al. Prediction of pulmonary embolism extent by clinical findings, d-dimer level and deep vein thrombosis shown by ultrasound. Thromb Haemost. 2001;86:1156–1160
  6. Hooker EA, O'Brien DJ, Danzyl DF, et al. Respiratory rates in emergency department patients. J Emerg Med. 1989;7:129–132
  7. Edmonds ZV, Mower WR, Lovato LM, et al. The reliability of vital sign measurements. Ann Emerg Med. 2002;39:233–237
  8. World Health Organization . Fourth Programme Report, 1988-1989: ARI Programme for Control of Acute Respiratory Infections. Geneva, Switzerland: WHO; 1990;31
  9. In:  Tintinalli JE,  Kelen GD,  Stapczynski JS editor. Emergency Medicine: A Comprehensive Study Guide. 6th ed.. New York, NY: McGraw-Hill; 2003;
  10. In:  Gunn VL,  Nechyba C editor. The Harriet Lane Handbook: A Manual for Pediatric House Officers. 16th ed.. St. Louis, MO: Mosby; 2002;p. 514
  11. Luce JM. Respiratory monitoring in critical care. In:  Goldman L,  Bennet JC editor. Cecil Textbook of Medicine. 21st ed.. Philadelphia, PA: WB Saunders; 2000;p. 485
  12. Mathers LH, Frankel LR. Stabilization of the critically ill child. In:  Behrman RE,  Kliegman RM,  Jenson HB editor. Nelson Textbook of Pediatrics. 17th ed.. Philadelphia, PA: WB Saunders; 2004;p. 280
  13. Haborne D. Measuring respiratory rate. Arch Emerg Med. 1992;9:377–378
  14. Gravelyn TR, Weg JG. Respiratory rate as an indicator of acute respiratory dysfunction. JAMA. 1980;244:1123–1125
  15. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1:307–310
  16. Morley CJ, Thornton AJ, Fowler MA, et al. Respiratory rate and severity of illness in babies under 6 months old. Arch Dis Child. 1990;65:834–837
  17. Mower WR, Sachs C, Nicklin EL, et al. A comparison of pulse oximetry and respiratory rate in patient screening. Respir Med. 1996;90:593–599
  18. Arnson LA, Rau JL, Dixon RJ. Evaluation of two electronic respiratory rate monitoring systems. Respir Care. 1981;26:221–227
  19. Taylor JA, Del Beccaro M, Done S, et al. Establishing clinically relevant standards for tachypnea in febrile children younger than 2 years. Arch Pediatr Adolesc Med. 1995;149:283–287
  20. Edwards SM, Murdin L. Respiratory rate: an under-documented clinical assessment. [letter] Clin Med. 2001;1:85
  21. Hutchinson J. Thorax. In:  Todd RB editors. Cyclopaedia of Anatomy and Physiology. London, United Kingdom: Longman, Brown, Green, Congmans and Roberts; 1849;p. 1079–1087
  22. Gilbert R, Auchincloss JH, Brodsky J, et al. Changes in tidal volume, frequency, and ventilation induced by their measurement. J Appl Physiol. 1972;33:252–254
  23. Berman S, Simoes EA, Lanata C. Respiratory rate and pneumonia in infancy. Arch Dis Child. 1991;66:81–84
  24. Simoes EAF, Roark R, Berman S, et al. Respiratory rate: measurement of variability over time and accuracy at different counting periods. Arch Dis Child. 1991;66:1199–1203
  25. Huang C, Koulouris M, Singer A. Accuracy of automated triage vital signs. [abstract] Ann Emerg Med. 2002;40:S87
  26. Clancy MJ, Williams MJ. The respiratory rate. [letter] Arch Emerg Med. 1991;8:222
  27. Krieger B, Feinerman D, Zaron A, et al. Continuous noninvasive monitoring of respiratory rate in critically ill patients. Chest. 1986;90:632–634
  28. Kory RC. Routine measurement of respiratory rate: an expensive tribute to tradition. JAMA. 1957;165:448–450
  29. Worster A, Elliott L, Bose TJ, et al. Reliability of vital signs measured at triage. Eur J Emerg Med. 2003;10:108–110
  30. Vegfors M, Ugnell H, Hök B, et al. Experimental evaluation of two new sensors for respiratory rate monitoring. Physiol Meas. 1993;14:171–181
  31. Egleston CV, Ben Aslam H, Lambert MA. Capnography for monitoring non-intubated spontaneously breathing patients in an emergency room setting. Emerg Med J. 1997;14:222–224
  32. Dodds D, Purdy J, Moulton C. The PEP transducer: a new way of measuring respiratory rate in the non-intubated patient. J Accid Emerg Med. 1999;16:26–28
  33. Manczur T, Greenough A, Hooper R, et al. Tidal breathing parameters in young children: comparison of measurement by respiratory inductance plethysmography to a facemask pneumotachograph system. Pediatr Pulmonol. 1999;28:436–441
  34. Marks MK, South M, Carter BG. Measurement of respiratory rate and timing using a nasal thermocouple. J Clin Monit. 1995;11:159–164
  35. Hök B, Wiklund L, Henneberg S. A new respiratory rate monitor: development and initial clinical experience. Int J Clin Monit Comput. 1993;10:101–107
  36. Marks MK, South M, Carlin JB. Reference ranges for respiratory rate measured by thermistry (12-84 months). Arch Dis Child. 1993;69:569–572
  37. Vegfors M, Lindberg L, Pettersson H, et al. Presentation and evaluation of a new optical sensor for respiratory rate monitoring. Int J Clin Monit Comput. 1994;11:151–156
  38. Pettersson H, Stenow END, Cai H, et al. Optical aspects of a fibre-optic sensor for respiratory rate monitoring. Med Biol Eng Comput. 1996;34:448–452
  39. Chow P, Gangadharan N, Abisheganaden J, et al. Respiratory monitoring using an air-mattress system. Physiol Meas. 2000;21:345–354
  40. Carlson BW, Neelon VJ, Hsiao H. Evaluation of a non-invasive respiratory monitoring system for sleeping subjects. Physiol Meas. 1999;20:53–63
  41. Alihanka J, Vaahtoranta K, Saarikivi I. A new method for long-term monitoring of the ballistocardiogram, heart rate, and respiration. Am J Physiol. 1981;240:R384–R392
  42. Cyna AM, Kulkarni V, Tunstall ME, et al. AURA: a new respiratory monitor and apnoea alarm for spontaneously breathing patients. Br J Anaesth. 1991;67:341–345
  43. Lindberg LG, Ugnell H, Oberg PA. Monitoring of respiratory and heart rates using a fibre-optic sensor. Med Biol Eng Comput. 1992;30:533–537
  44. Nilsson L, Johansson A, Kalman S. Monitoring of respiratory rate in postoperative care using a new photoplethysmographic technique. J Clin Monit Comput. 2000;16:309–315
  45. Hamilton LH, Beard JD, Carmean RE, et al. An electrical impedance ventilometer to quantitate tidal volume and ventilation. Med Res Eng. 1967;6:11–16
  46. Allison RD, Holmes EL, Nyboer J. Volumetric dynamics of respiration as measured by electrical impedance plethysmography. J Appl Physiol. 1964;19:166–173
  47. Ashutosh K, Gilbert R, Auchincloss JH, et al. Impedance pneumograph and magnetometer methods for monitoring tidal volume. J Appl Physiol. 1974;37:964–966

 Author contributions: PBL obtained equipment on loan free of charge for use in the study. PBL, JMB, and KS conceived the study, designed the trial, and supervised the conduct of the trial. PBL and JMB collected data. PB and PBL analyzed the data. PBL drafted the manuscript, and all authors contributed substantially to its revision. PBL takes responsibility for the paper as a whole.Presented orally at the Society for Academic Emergency Medicine New York regional meeting, New York, NY, April 9, 2003; as a poster at the Society for Academic Emergency Medicine annual meeting, Boston, MA, May to June, 2003; as a finalist for Best Resident Research Paper at the Society for Academic Emergency Medicine annual meeting, Boston, MA, May to June, 2003; and as a poster at the Second Mediterranean Emergency Medicine Congress, Barcelona, Spain, September 2003.Previously published as an abstract in Lovett PB, Buchwald JM, Stürman K, et al. The vexatious vital: a comparison of clinical vs electronic measurement of respiratory rate in triage. Acad Emerg Med. 2003;10:552-553.Two Escort Prism monitors for transthoracic impedance plethysmography measurement were loaned free of charge for the study by Medical Data Electronics.Reprints not available from the authors.

PII: S0196-0644(04)00649-3

doi: 10.1016/j.annemergmed.2004.06.016

Annals of Emergency Medicine
Volume 45, Issue 1 , Pages 68-76 , January 2005

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