Clinical respiratory scales: which one should we use?

Area of Science:

• Respiratory Medicine
• Clinical Assessment Tools
• Medical Informatics

Background:

• Numerous clinical respiratory scales exist for assessing acute dyspnoea.
• Healthcare professionals often select scales based on personal experience or local customs, lacking awareness of comparative implications.
• A critical gap in comparative analysis of these tools has historically existed, with validation studies emerging only recently.

Purpose of the Study:

• To assess and compare the quality criteria and measurement properties of existing acute dyspnoea scores.
• To critically evaluate the validity, reliability, and utility of 41 selected scoring instruments.
• To identify methodological shortcomings and differences in study designs and sample selections across available scales.

Main Methods:

• A comprehensive literature review was conducted using the PubMed database.
• Forty-five documents reporting the development or use of clinical scales for acute respiratory dyspnoea were identified.
• The study focused on 41 eligible instruments, analyzing their validity, reliability, and utility.

Main Results:

• All reviewed acute dyspnoea scores exhibit incomplete validation.
• Key areas such as measurement error and interpretability have not been sufficiently addressed by any of the evaluated tools.
• Frequent modifications to existing scores, varied study designs, and source discrepancies complicate the selection of an adequate tool.

Conclusions:

• Current clinical scales for acute dyspnoea are not fully validated, particularly concerning measurement error and interpretability.
• The heterogeneity in scale design, validation methodologies, and reporting hinders the identification of optimal tools for clinical practice.
• Further rigorous validation studies are needed to improve the selection and application of acute dyspnoea scoring instruments.