Mild, moderate, and severe intensity cut-points for the Respiratory Distress Observation Scale

•Intensity cut-point has been identified for the RDOS.•Cut-point identification enhances clinical utility.•Cut-point identification affords use in efficacy trials.

BackgroundThe Respiratory Distress Observation Scale© (RDOS) is a means for assessing respiratory distress when a patient is unable to give a dyspnea self-report. Cut-point determination was needed to guide clinical application.MethodA Receiver Operating Characteristic (ROC) curve analysis was conducted in a prospective, observation study with inpatients ranked by nurse practitioners (NP) into levels of respiratory distress. A research assistant simultaneously measured RDOS blinded to NP ranking.ResultsParticipants were 84 adults: mean age of 72.6 (SD = 15.2) years, 53.6% male, 77.4% African-American. NP ranking was distributed: none (30%), mild (26%), moderate (31%), and severe (13%) distress. RDOS scores ranged 0-13 (M = 4.8, SD = 3). NP ranking was significantly correlated with RDOS (rho = .91, p < .01). ROC curve analyses yielded cut-points: none = 0-2, any = 3, mild-moderate = 4-6, and severe ≥7 (p < .01).ConclusionsIntensity cut-point enhances the clinical utility of the RDOS.