Rapid systematic review of respiratory rate as a vital sign of clinical deterioration in COVID-19

ABSTRACT

Objectives

This meta-analysis aimed to establish a clinical evidence base for respiratory rate (RR) as a single predictor of early-onset COVID-19. The review also looked to determine the practical implementation of mobile respiratory rate measuring devices where information was available.

Methods

We focused on domestic settings with older adults. Relevant studies were identified through MEDLINE, Embase, and CENTRAL databases. A snowballing method was also used. Articles published from the beginning of the COVID-19 pandemic (2019) until Feb 2022 were selected. Databases were searched for terms related to COVID-19 and respiratory rate measurements in domestic patients.

Results

A total of 2,889 articles were screened for relevant content, of which 60 full-text publications were included. We compared the Odds Ratios and statistically significant results of both vital signs.

Conclusion

Multinational studies across dozens of countries have shown respiratory rate to have predictive accuracy in detecting COVID-19 deterioration. However, considerable variability is present in the data, making it harder to be sure about the effects. There is no meaningful difference in data quality in terms of variability (95% CI intervals) between vital signs as predictors of decline in COVID-19 patients. Contextual and economic factors will likely determine the choice of measurement used.

KEYWORDS:

• Respiratory rate
• COVID-19
• SARS-CoV-2
• oxygen saturation
• clinical deterioration
• mobile

Acknowledgments

We would like to thank the staff from Boxhealth for their support in preparing this manuscript and Mr Moyeen Ahmad.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Both John Tredinnick-Rowe (JT-R) and Rehan Symonds (RS) were involved in the conception, design, interpretation and analysis of the data in this publication. Equally, both JT-R and RS were involved in the drafting and critical revising of the manuscript content. This includes the original submission, revisions and the final approved version of the manuscript. All authors (JT-R and RS) agree to be accountable for all aspects of the work.

Additional information

Funding

This work was supported by N.E. Device S.W. Ltd