Assessment of Respiratory Distress by the Roth Score

Clin Cardiol. 2016 Nov;39(11):636-639. doi: 10.1002/clc.22586. Epub 2016 Oct 4.


Introduction: 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.

Hypothesis: 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.

Keywords: Respiratory Distress; hypoxia; telemedicine.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Area Under Curve
  • Case-Control Studies
  • Dyspnea / diagnosis*
  • Dyspnea / physiopathology
  • Female
  • Humans
  • Lung / physiopathology*
  • Male
  • Middle Aged
  • Oximetry
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • ROC Curve
  • Remote Consultation / methods*
  • Reproducibility of Results
  • Respiration*
  • Respiratory Function Tests / methods*
  • Severity of Illness Index
  • Time Factors