title: Assessment of Respiratory Distress by the Roth Score.
abstract: BACKGROUND
  Health care demand is increasing due to greater longevity of patients with chronic comorbidities. This increasing demand is occurring in a setting of resource scarcity. To address these changes, high-value care initiatives, such as telemedicine, are valuable resource-preservation strategies. This study introduces the Roth score as a telemedicine tool that uses patient counting times to accurately risk-stratify dyspnea severity in terms of hypoxia.
  
  
  OBJECTIVE
  The Roth score has correlation with dyspnea severity.
  
  
  METHODS
  This is a prospective, controlled-cohort study. Roth score index is measured by having the patient count from 1 to 30 in their native language, in a single breath, as rapidly as possible. The primary result of the Roth score is the duration of time and the highest number reached.
  
  
  RESULTS
  There was a strongly positive correlation between pulse oximetry and both maximal count achieved in 1 breath (r = 0.67; P < 0.001) and counting time (r = 0.59; P < 0.001). For oxygen saturation <95%, the maximal count number area under the curve is 0.828 and counting time area under the curve is 0.764. Counting time >8 seconds had a sensitivity of 78% and specificity of 73% for pulse oximetry <95%.
  
  
  CONCLUSIONS
  The Roth score has strong correlation with dyspnea severity as determined by hypoxia. This tool is reproducible, low resource-utilization, and amenable to telemedicine. It is not intended to replace full clinical workup and diagnosis of respiratory distress, but it is useful in risk-stratifying severity of dyspnea that warrants further clinical evaluation.
authors.affiliation: Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Ehud
authors.initials: E
authors.lastname: Chorin
authors.affiliation: Department of Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Allison
authors.initials: A
authors.lastname: Padegimas
authors.affiliation: Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Ofer
authors.initials: O
authors.lastname: Havakuk
authors.affiliation: Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.|Department of Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.|Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Edo Y
authors.initials: EY
authors.lastname: Birati
authors.affiliation: Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Yacov
authors.initials: Y
authors.lastname: Shacham
authors.affiliation: Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Anat
authors.initials: A
authors.lastname: Milman
authors.affiliation: Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Guy
authors.initials: G
authors.lastname: Topaz
authors.affiliation: Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Nir
authors.initials: N
authors.lastname: Flint
authors.affiliation: Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Gad
authors.initials: G
authors.lastname: Keren
authors.affiliation: Department of Internal Medicine "C", Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Ori
authors.initials: O
authors.lastname: Rogowski
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D016022:Case-Control Studies; D004417:Dyspnea / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010092:Oximetry; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D019114:Remote Consultation / Q000379:methods*; D015203:Reproducibility of Results; D012119:Respiration; D012129:Respiratory Function Tests / Q000379:methods*; D012720:Severity of Illness Index; D013997:Time Factors
keywords: Respiratory Distress; hypoxia; telemedicine