National Cancer Centre Singapore, Singapore.
National Cancer Centre Singapore, Singapore; Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore.
J Pain Symptom Manage. 2019 Feb;57(2):304-310. doi: 10.1016/j.jpainsymman.2018.10.506. Epub 2018 Nov 2.
The prevalence and severity of dyspnea increase at the end of life. Many of these patients have difficulty in reporting their symptoms. Accurate surrogate measures are needed for appropriate assessment and treatment. The Respiratory Distress Observation Scale (RDOS) is proposed as a possible scale although more external validation is needed. We set out to validate the RDOS in the context of palliative care patients near the end of life.
We prospectively studied 122 palliative care patients in a tertiary hospital in Singapore. Prior RDOS training was done using a standardized instructional video. Dyspnea was assessed by RDOS, Dyspnea Numerical Rating Scale, and Dyspnea Categorical Scale. Pain was assessed by Pain Numerical Rating Scale. We measured RDOS inter-rater reliability, convergent validity, and divergent validity. We used area under receiver operating characteristics curve (AUC) analysis to examine the discriminant properties of RDOS using dyspnea self-report as benchmark.
RDOS had good inter-rater reliability with an intraclass correlation of 0.947 (95% CI 0.919-0.976). It showed moderate-to-strong correlation with Dyspnea Numerical Rating Scale (r = 0.702) and Dyspnea Categorical Scale (r = 0.677) and negligible correlation to Pain Numerical Rating Scale (r = 0.080). It showed good discriminant properties of identifying patients with moderate and severe dyspnea with an AUC of 0.874 (95% CI 0.812-0.936). RDOS ≥ 4 predicted patients with moderate and severe dyspnea with a sensitivity of 76.6%, specificity of 86.2%, positive predictive value of 86.0%, and negative predictive value of 76.9%.
The RDOS shows promise and clinical utility as an observational dyspnea assessment tool. Further studies in uncommunicative patients are needed to determine clinical usefulness and generalizability of results.
呼吸困难在生命末期的发生率和严重程度增加。这些患者中有许多难以报告其症状。需要准确的替代指标来进行适当的评估和治疗。呼吸窘迫观察量表(RDOS)被提议作为一种可能的量表,尽管需要更多的外部验证。我们着手在生命末期的姑息治疗患者中验证 RDOS。
我们在新加坡的一家三级医院前瞻性研究了 122 名姑息治疗患者。在进行 RDOS 培训之前,我们使用了标准化教学视频。通过 RDOS、呼吸困难数字评分量表和呼吸困难分类量表评估呼吸困难。通过疼痛数字评分量表评估疼痛。我们测量了 RDOS 的组内相关性、收敛有效性和发散有效性。我们使用接受者操作特征曲线下面积(AUC)分析来评估 RDOS 的鉴别特性,以呼吸困难自我报告为基准。
RDOS 具有良好的组内相关性,组内相关系数为 0.947(95%置信区间为 0.919-0.976)。它与呼吸困难数字评分量表(r=0.702)和呼吸困难分类量表(r=0.677)呈中度至强相关,与疼痛数字评分量表(r=0.080)呈弱相关。它具有良好的鉴别特性,AUC 为 0.874(95%置信区间为 0.812-0.936),可识别中度和重度呼吸困难患者。RDOS≥4 预测中度和重度呼吸困难患者的敏感性为 76.6%,特异性为 86.2%,阳性预测值为 86.0%,阴性预测值为 76.9%。
RDOS 作为一种观察性呼吸困难评估工具具有一定的前景和临床应用价值。需要进一步研究无法交流的患者,以确定其临床实用性和结果的普遍性。