Diagnostic accuracy of tachypnoea for predicting mortality and identifying sepsis in young infants aged 0–59 days: a systematic review and meta-analysis
Suci Ardini Widyaningsih, Sophie Driker, Alastair Fung, Naomi Schmeck, Sitarah Mathias, Megan Yu, Yasir Shafiq, Amber Hoey, Tessa Kehoe, Yumin Kim, Jana Adnan, Anum S Hussaini, Carrie G Wade, Anne CC LeeBackground
Tachypnoea is a danger sign for predicting mortality and identifying sepsis. We systematically reviewed evidence on the diagnostic accuracy of different tachypnoea thresholds for predicting mortality and sepsis in infants aged 0–59 days.
Methods
We searched MEDLINE, Embase, CINAHL, Global Index Medicus and CENTRAL for studies reporting associations or diagnostic accuracy of tachypnoea (≥60, ≥70 or ≥80 breaths per minute (bpm)) for predicting mortality and culture-confirmed sepsis in infants aged 0–59 days. We followed Cochrane methods for study screening, data extraction and quality assessment. We pooled ORs using random-effects models and sensitivity/specificity using random-effects bivariate models. We used GRADE (Grading of Recommendations, Assessment, Development and Evaluation) to assess the certainty of evidence.
Results
Of 7641 studies identified, 18 were included (n=92 398). Tachypnoea≥60 bpm had a pooled OR of 3.14 (95% CI 1.30 to 7.56; 5 studies; n=10 407) for predicting mortality and a sensitivity of 31% (95% CI 19% to 45%) and a specificity of 89% (95% CI 66% to 97%; 4 studies; n=7104). For culture-confirmed sepsis, tachypnoea≥60 bpm had an OR of 1.26 (95% CI 0.66 to 2.38; 4 studies; n=3996), and a sensitivity of 28% (95% CI 10% to 58%) and a specificity of 67% (95% CI 53% to 78%; 3 studies; n=693). The higher threshold of tachypnoea≥70 bpm was associated with a higher odds of mortality (OR 10.06 (95% CI 2.39 to 42.35); 2 studies; n=12 138) and resulted in higher specificity (99.4% (95% CI 99.1% to 99.6%)) but lower sensitivity (10.9% (95% CI 5.3% to 19.1%)) for mortality (1 study; n=5214). Data were insufficient to assess performance by age subgroup (0–6 vs 7–59 days). The certainty of evidence was very low.
Conclusions
Tachypnoea≥60 bpm is associated with a threefold increased odds of mortality in young infants, supporting its use as a danger sign. Given its relatively low sensitivity alone, tachypnoea should be interpreted alongside other clinical signs to optimise diagnostic accuracy. While higher thresholds (≥70 bpm) demonstrated stronger associations and increased specificity for predicting mortality, low sensitivity may limit clinical utility.
PROSPERO registration number
CRD42023431387.