title: Intensity cut-points for the Respiratory Distress Observation Scale.
abstract: BACKGROUND
  The Respiratory Distress Observation Scale(©) is an innovative solution to assessment when a dyspnea report cannot be elicited. The Respiratory Distress Observation Scale has acceptable reliability and validity psychometrics.
  
  
  OBJECTIVE
  To identify distress-intensity cut-points of the Respiratory Distress Observation Scale.
  
  
  METHODS
  Receiver operating characteristic curve analysis was conducted with inpatients stratified by four levels of respiratory distress-none, mild, moderate, or severe. Patients provided three self-report measures of dyspnea: dichotomous (yes/no); a ranking of none, mild, moderate, or severe; and a numerical rating scale. Respiratory distress was assessed using the Respiratory Distress Observation Scale instrument.
  
  
  METHODS
  Participants were 136 adult inpatients, mean age 61.8 years (standard deviation = 13.18 years), 89.7% African American, and 56.6% female, who were recruited from an urban, tertiary care hospital in the Midwest of the United States.
  
  
  RESULTS
  In all, 47% (n = 64) self-reported dyspnea (yes/no). Ranking was distributed as follows: none = 36, mild = 35, moderate = 40, and severe = 25. Numerical rating scale scores ranged from 0 to 10, mean = 4.99 (standard deviation = 2.9). Respiratory Distress Observation Scale scores ranged from 0 to 7, median (interquartile range) = 2 (1-3). Receiver operating characteristic curve analysis-determined Respiratory Distress Observation Scale score of 0-2 suggests little or no respiratory distress; score ≥3 signified moderate to severe distress.
  
  
  CONCLUSIONS
  A Respiratory Distress Observation Scale score ≥3 signifies a patient's need for palliation of respiratory distress. An end-point for identifying responsiveness to treatment, in other words, respiratory comfort, is Respiratory Distress Observation Scale <3. Because patients with imminent respiratory failure, as typified by dying patients, were not represented yielding lower than expected Respiratory Distress Observation Scale scores, further substantiation is needed to determine moderate or severe cut-points.
authors: College of Nursing, Wayne State University, Detroit, MI, USA m.campbell@wayne.edu.
authors: Margaret L
authors: ML
authors: Campbell
authors: College of Nursing, Wayne State University, Detroit, MI, USA.
authors: Thomas N
authors: TN
authors: Templin
mesh_terms: D000328:Adult; D000368:Aged; D004417:Dyspnea / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D011594:Psychometrics; D012372:ROC Curve; D015203:Reproducibility of Results; D012131:Respiratory Insufficiency / Q000175:diagnosis*; D012720:Severity of Illness Index; D014481:United States
keywords: Dyspnea; psychometrics; respiratory insufficiency; symptom assessment
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