{
  "abstract": "Background 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.",
  "authors": [
    {
      "affiliations": [
        "Department of Pediatrics, Division of Newborn Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA",
        "Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Suci Ardini Widyaningsih"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Division of Newborn Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA"
      ],
      "name": "Sophie Driker"
    },
    {
      "affiliations": [
        "Division of Paediatric Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada",
        "Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada"
      ],
      "name": "Alastair Fung"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Division of Newborn Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA",
        "Department of Health and Kinesiology, University of Nebraska at Omaha, Omaha, Nebraska, USA"
      ],
      "name": "Naomi Schmeck"
    },
    {
      "affiliations": [
        "Harvard Medical School, Boston, Massachusetts, USA",
        "Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA"
      ],
      "name": "Sitarah Mathias"
    },
    {
      "affiliations": [
        "Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA"
      ],
      "name": "Megan Yu"
    },
    {
      "affiliations": [
        "Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada",
        "Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan",
        "Center of Excellence for Trauma and Emergencies, Aga Khan University, Karachi, Pakistan"
      ],
      "name": "Yasir Shafiq"
    },
    {
      "affiliations": [
        "Bryn Mawr College, Bryn Mawr, Pennsylvania, USA"
      ],
      "name": "Amber Hoey"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Division of Newborn Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA",
        "Oregon Health and Science University, Portland, Oregon, USA"
      ],
      "name": "Tessa Kehoe"
    },
    {
      "affiliations": [
        "Brown Global Alliance for Infant and Maternal Health Research, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA"
      ],
      "name": "Yumin Kim"
    },
    {
      "affiliations": [
        "Vayu Global Health Foundation, Medford, Massachusetts, USA",
        "Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA"
      ],
      "name": "Jana Adnan"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Division of Newborn Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA",
        "Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA"
      ],
      "name": "Anum S Hussaini"
    },
    {
      "affiliations": [
        "Countway Library, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Carrie G Wade"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Division of Newborn Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA",
        "Brown Global Alliance for Infant and Maternal Health Research, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA"
      ],
      "name": "Anne CC Lee"
    }
  ],
  "title": "Diagnostic accuracy of tachypnoea for predicting mortality and identifying sepsis in young infants aged 0–59 days: a systematic review and meta-analysis",
  "uid": "46216d9b-5d19-52c2-8958-c6b84b4e4297"
}