Clinical respiratory scales: which one should we use?

ABSTRACT

Introduction: There are countless clinical respiratory scales for acute dyspnoea. Most healthcare professionals choose one based on previous personal experience or following local practice, unaware of the implications of their choice. The lack of critical comparisons between those different tools has been a widespread problem that only recently has begun to be addressed via score validation studies. Here we try to assess and compare the quality criteria of measurement properties of acute dyspnoea scores.

Areas covered: A literature review was conducted by searching the PubMed database. Forty-five documents were deemed eligible as they reported the use or building of clinical scales, using at least two parameters, and applied these to an acute episode of respiratory dyspnoea. Our primary focus was the description of the validity, reliability and utility of 41 suitable scoring instruments. Differences in sample selection, study design, rater profiles and potential methodological shortcomings were also addressed.

Expert commentary: All acute dyspnoea scores lack complete validation. In particular, the areas of measurement error and interpretability have not been addressed correctly by any of the tools reviewed. Frequent modification of pre-existing scores (in items composition and/or name), differences in study design and discrepancies in reviewed sources also hinder the search for an adequate tool.

KEYWORDS:

• Asthma
• bronchiolitis
• dyspnoea score
• respiratory distress
• respiratory scale
• review
• validation
• wheezing

Declaration of interest

All authors were involved in the development and validation of two of the evaluated scores (ReSVinet and pReSVinet) included in the review. F Martinon-Torres has received financial support from the Instituto de Salud Carlos III and ‘fondos FEDER’ through the Intesificacion de la actividad invetigadora 2012-2017 and Proyecto de Investigacion en Salud, Accion Estrategica en Salud FIS PI16/01569, and also through 2016-PG071 Consolidacion e Estructuracion REDES 2016GI-1344 G3VIP (Grupo Gallego de Genetica Vacunas Infecciones y Pediatria, ED341D R2016/021). AJ Justicia-Grande is supported by a FP7 European Grant (279185). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This article has not receive any funding.