Mild, moderate, and severe intensity cut-points for the Respiratory Distress Observation Scale©: A receiver operating characteristic curve analysis Margaret.

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Mild, moderate, and severe intensity cut-points for the Respiratory Distress Observation Scale©: A receiver operating characteristic curve analysis Margaret L. Campbell, PhD, RN, FPCN; Thomas N. Templin, PhD; Katherine K. Kero, BSN, RN College of Nursing, Wayne State University, Detroit, MI Background Sample Results The Respiratory Distress Observation Scale© (RDOS) is a novel solution to assessment when a dyspnea report cannot be elicited due to patient cognitive impairment or unconsciousness. RDOS inter-rater and scale reliability, construct, convergent, and discriminant validity have been established and previously reported. Preliminary cut-point with cognitively intact proxies was established. Further study was needed with intended RDOS population 84 adult patients (power 82%) Mean age = 72.6 (SD = 15.2) years Race = African-American (78%) and Caucasian (22%) Gender = evenly distributed Diagnoses Heart failure (14%) Lung disease (14%) Pneumonia (48%) Mixed diagnoses (20%) Lung cancer (4%) SpO2 (M = 95%, SD = 6) ranging 60-100% FiO2 (M = 0.44, SD = 0.28) ranging 0.21-1.0 NP rankings None = 30% Mild = 26% Moderate = 31% Severe = 13% RDOS scores (M = 4.84, SD = 3.1) ranging 0-13 NP ranking – RDOS (rho = 0.91, p<.01) RDOS – SpO2 (rho = -0.24, p<.05) RDOS – FiO2 (rho = 0.42, p<.01) Figure 1. Relationship of NP rankings to RDOS Aim To identify distress intensity cut-points of the RDOS Method Receiver Operating Characteristic (ROC) curve analysis Table 1. Respiratory Distress Observation Scale (RDOS) © Table 2. ROC curve analyses Sample stratified by expert Palliative Care Nurse Practitioner identified levels of respiratory distress: none, mild, moderate or severe Research Assistant scored RDOS blinded to NP ranking Adult hospitalized patients at-risk for dyspnea with one or more of the following conditions: Lung disease Heart failure Lung cancer Pneumonia Near death: Palliative Performance Scale ≤20 Exclusion (RDOS invalid) Quadriplegia ALS Conclusion Cut-point identification enhances RDOS clinical utility, may be applied to treatment regimens, and may be used in respiratory distress efficacy trials Funding Detroit Medical Center-WSU College of Nursing Scholar Grant