title: The accuracy of human senses in the detection of neonatal heart rate during standardized simulated resuscitation: implications for delivery of care, training and technology design.
abstract: OBJECTIVE
  Auscultation and palpation are recommended methods of determining heart rate (HR) during neonatal resuscitation. We hypothesized that: (a) detection of HR by auscultation or palpation will vary by more than ± 15BPM from actual HR; and (b) the inability to accurately determine HR will be associated with errors in management of the neonate during simulated resuscitation.
  
  
  METHODS
  Using a prospective, randomized, controlled study design, 64 subjects participated in three simulated neonatal resuscitation scenarios. Subjects were randomized to technique used to determine HR (auscultation or palpation) and scenario order. Subjects verbalized their numeric assessment of HR at the onset of the scenario and after any intervention. Accuracy of HR determination and errors in resuscitation were recorded. Errors were classified as errors of omission (lack of appropriate interventions) or errors of commission (inappropriate interventions). Cochran's Q and chi square test were used to compare HR detection by method and across scenarios.
  
  
  RESULTS
  Errors in HR determination occurred in 26-48% of initial assessments and 26-52% of subsequent assessments overall. There were neither statistically significant differences in accuracy between the two techniques of HR assessment (auscultation vs palpation) nor across the three scenarios. Of the 90 errors in resuscitation, 43 (48%) occurred in association with errors in HR determination.
  
  
  CONCLUSIONS
  Determination of heart rate via auscultation and palpation by experienced healthcare professionals in a neonatal patient simulator with standardized cues is not reliable. Inaccuracy in HR determination is associated with errors of omission and commission. More reliable methods for HR assessment during neonatal resuscitation are required.
authors.affiliation: Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA, USA. ritu79@gmail.com.
authors.forename: Ritu
authors.initials: R
authors.lastname: Chitkara
authors.forename: Anand K
authors.initials: AK
authors.lastname: Rajani
authors.forename: John W
authors.initials: JW
authors.lastname: Oehlert
authors.forename: Henry C
authors.initials: HC
authors.lastname: Lee
authors.forename: M S
authors.initials: MS
authors.lastname: Epi
authors.forename: Louis P
authors.initials: LP
authors.lastname: Halamek
mesh_terms: D001314:Auscultation / Q000379:methods*; D003198:Computer Simulation; D003695:Delivery of Health Care / Q000592:standards*; D006339:Heart Rate; D006801:Humans; D007231:Infant, Newborn; D007396:Internship and Residency / Q000379:methods*; D008505:Medical Staff, Hospital / Q000193:education; D010173:Palpation / Q000379:methods*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012151:Resuscitation / Q000193:education / Q000379:methods* / Q000592:standards