Developing a video expert panel as a reference standard to evaluate respiratory rate counting in paediatric pneumonia diagnosis: protocol for a cross-sectional study

AbstractIntroductionManual counting of respiratory rate (RR) in children is challenging for health workers and can result in misdiagnosis of pneumonia. Some novel RR counting devices automate the counting of RR and classification of fast breathing. The absence of an appropriate reference standard to evaluate the performance of these devices is a challenge. If good quality videos could be captured, with RR interpretation from these videos systematically conducted by an expert panel, it could act as a reference standard. This study is designed to develop a video expert panel (VEP) as a reference standard to evaluate RR counting for identifying pneumonia in children.Methods and analysisUsing a cross-sectional design, we will enrol children aged 0-59 months presenting with suspected pneumonia at different levels of health facilities in Dhaka and Sylhet, Bangladesh. We will video record a physician/health worker counting RR manually and also using an automated RR counter (ChARM) from each child. We will establish a standard operating procedure for capturing quality videos, make a set of reference videos, and train and standardise the VEP members using the reference videos. After that, we will assess the performance of the VEP as a reference standard to evaluate RR counting. We will calculate the mean difference and proportions of agreement within ±2 breaths per minute and create Bland-Altman plots with limits of agreement between VEP members.Ethics and disseminationThe study protocol was approved by the National Research Ethics Committee of Bangladesh Medical Research Council (BMRC), Bangladesh (registration number: 39315022021) and Edinburgh Medical School Research Ethics Committee (EMREC), Edinburgh, UK (REC Reference: 21-EMREC-040). Dissemination of the study findings will be through conference presentations and publications in peer-reviewed scientific journals.Strengths and limitations of this studyExpert paediatricians will provide feedback to develop a standard operating procedure for videography of child chest movements.The video expert panel will be trained and standardized using the expert paediatrician-interpreted reference videos.Video expert panel members will be masked to respiratory rate counted by each other and to respiratory rate manual counts, and with the automated counter.Children with varying severity of illness will be enrolled from different levels of health facilities in Bangladesh.Despite the availability of multiple respiratory rate counters, only the ChARM device will be used in this study.