In Reply: We concur with Dr Manning that the respiratory rate is an important component of the physical examination; it may identify patients who require more intensive monitoring or further investigation. Our search strategy in this systematic review included search terms such as vital sign, clinical observation, and mouth breathing, and also a hand-search of the bibliographies of retrieved articles. Surprisingly, we did not identify any studies meeting our inclusion and exclusion criteria that discussed the diagnostic accuracy of respiratory rate in the context of pleural effusion. This certainly would be an interesting study for patients presenting with pulmonary symptoms suspected of pleural effusion.
Wong CL, Holroyd-Leduc JM, Straus SE. Respiratory Rate and Diagnosis of Pleural Effusion—Reply. JAMA. 2009;301(19):1989-1990. doi:10.1001/jama.2009.654