title: Diagnostic Accuracy of Respiratory Distress Observation Scales as Surrogates of Dyspnea Self-report in Intensive Care Unit Patients.
abstract: BACKGROUND
  Dyspnea, like pain, can cause major suffering in intensive care unit (ICU) patients. Its evaluation relies on self-report; hence, the risk of being overlooked when verbal communication is impaired. Observation scales incorporating respiratory and behavioral signs (respiratory distress observation scales [RDOS]) can provide surrogates of dyspnea self-report in similar clinical contexts (palliative care).
  
  
  METHODS
  The authors prospectively studied (single center, 16-bed ICU, large university hospital) 220 communicating ICU patients (derivation cohort, 120 patients; separate validation cohort, 100 patients). Dyspnea was assessed by dyspnea visual analog scale (D-VAS) and RDOS calculated from its eight components (heart rate, respiratory rate, nonpurposeful movements, neck muscle use during inspiration, abdominal paradox, end-expiratory grunting, nasal flaring, and facial expression of fear). An iterative principal component analysis and partial least square regression process aimed at identifying an optimized D-VAS correlate (intensive care RDOS [IC-RDOS]).
  
  
  RESULTS
  In the derivation cohort, RDOS significantly correlated with D-VAS (r = 0.43; 95% CI, 0.29 to 0.58). A five-item IC-RDOS (heart rate, neck muscle use during inspiration, abdominal paradox, facial expression of fear, and supplemental oxygen) significantly better correlated with D-VAS (r = 0.61; 95% CI, 0.50 to 0.72). The median area under the receiver operating curve of IC-RDOS to predict D-VAS was 0.83 (interquartile range, 0.81 to 0.84). An IC-RDOS of 2.4 predicted D-VAS of 4 or greater with equal sensitivity and specificity (72%); an IC-RDOS of 6.3 predicted D-VAS of 4 or greater with 100% specificity. Similar results were found in the validation cohort.
  
  
  CONCLUSIONS
  Combinations of observable signs correlate with dyspnea in communicating ICU patients. Future studies in noncommunicating patients will be needed to determine the responsiveness to therapeutic interventions and clinical usefulness.
authors.affiliation: From the AP-HP, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), Paris, France (R.P., M.S., J.M., A.D., C.M.-P., T.S.); AP-HP, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Pôle Biologie Médicale et Pathologie, Service de Parasitologie et Mycologie, Paris, France (F.G.); Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique," Paris, France (M.S., C.M.-P., T.S.); INSERM, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique," Paris, France (M.S., C.M.-P., T.S.); Sorbonne Universités, UPMC Univ Paris 06, UMR_S 974 Equipe 1, Paris, France (A.D.); and INSERM, UMR_S 974 Equipe 1, Paris, France (A.D.).
authors.forename: Romain
authors.initials: R
authors.lastname: Persichini
authors.forename: Frédérick
authors.initials: F
authors.lastname: Gay
authors.forename: Matthieu
authors.initials: M
authors.lastname: Schmidt
authors.forename: Julien
authors.initials: J
authors.lastname: Mayaux
authors.forename: Alexandre
authors.initials: A
authors.lastname: Demoule
authors.forename: Capucine
authors.initials: C
authors.lastname: Morélot-Panzini
authors.forename: Thomas
authors.initials: T
authors.lastname: Similowski
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods / Q000592:standards*; D004417:Dyspnea / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000175:diagnosis* / Q000628:therapy; D057566:Self Report / Q000592:standards*