Accuracy of Respiratory Distress Observational Scale (RDOS) in the emergency department

Area of Science:

• Emergency Medicine
• Clinical Assessment
• Respiratory Physiology

Background:

• Dyspnea, a subjective breathing discomfort, is commonly assessed using patient-reported scales like the Numerical Rating Scale (NRS).
• The Respiratory Distress Observation Scale (RDOS) offers an observational alternative for dyspnea assessment, particularly valuable in patients with communication challenges.

Purpose of the Study:

• To evaluate the diagnostic accuracy of the RDOS in assessing dyspnea severity within the emergency department (ED).
• To determine an optimal cutoff point for the RDOS to differentiate between varying levels of dyspnea severity.

Main Methods:

• A cross-sectional observational study nested within a previous inter-rater reliability investigation of RDOS.
• Emergency physicians assessed dyspnea severity using RDOS in adult patients presenting with dyspnea, excluding those with impaired communication.
• Patient-reported NRS scores were collected concurrently for comparison.

Main Results:

• The study included 122 patients and 44 emergency physicians.
• Median self-reported NRS was 7 (interquartile range [IQR] 5-8), and median RDOS was 5 (IQR 3-7).
• An RDOS cutoff of ≥4 demonstrated the highest accuracy (AUC 0.783), with 65.7% sensitivity and 90.9% specificity for distinguishing mild from moderate-to-severe dyspnea.

Conclusions:

• The RDOS is a viable observational tool for assessing dyspnea severity in communicative emergency department patients.
• An RDOS cutoff score of ≥4 effectively differentiates mild from moderate-to-severe dyspnea in the ED setting.