Factors associated with interpretability and agreement in respiratory rate counts between experts from recorded videos of children under five years of age

Abstract Background The videography of child chest movements and its interpretation by experts could be an ideal reference standard to evaluate respiratory rate (RR) count to aid childhood pneumonia diagnosis. The study aimed to determine the factors associated with interpretability and agreement of RR counts derived by experts from recorded videos of chest movements in children under five years of age. Methods Thirty hospitalized children aged 1–59 months with suspected pneumonia were video-recorded breathing four times. Two paediatricians subsequently evaluated the videos and counted RR. Interpretability was defined as both paediatricians being able to interpret RR and agreement was defined as the difference in RR counts of ≤2 breaths per minute (bpm). Results Eighty-five videos of RR measurements were recorded. There was agreement in the ability to interpret RR in 73/85 (85.9%) videos, and agreement for RR counts in 54/73 (74.0%) of interpretable videos. A higher adjusted odds ratio (aOR) for the ability of interpretability in RR counts was found if the child was calm or sleeping compared to moving (aOR = 73.6; 95% CI 9.1, 594.0; p < 001), or lying on the bed compared to on the parent’s lap (aOR = 22.8; 95% CI 2.9, 179.0; p = 0.003). A higher aOR for agreement in RR counts was found if the RR was <40 bpm (aOR = 21.4; 95% CI 3.1, 149.7; p = 0.002) and 40–59 bpm (aOR = 7.4; 95% CI 1.2, 45.2; p = 0.030), compared to RR ≥ 60 bpm. Conclusion Child movements, child position and higher RR affect interpretability and/or agreement in RR counts between experts. These factors should be considered during the videography of RR measurement and its interpretation.