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

Assessment of Respiratory Distress by the Roth Score

Free PMC article

Assessment of Respiratory Distress by the Roth Score

Ehud Chorin et al. Clin Cardiol. .
Free PMC article


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.

Conflict of interest statement

The authors have no other funding, financial relationships, or conflicts of interest to disclose.


Figure 1
Figure 1
The correlation between the pulse oximetry measurement on room air and both the maximal count achieved in 1 breath and the counting time. Abbreviations: sec, seconds.
Figure 2
Figure 2
The ROC curve with room‐air saturation as the primary variable to evaluate the predictive value of the counting time and the maximal number reached on dyspnea (as characterized by room‐air pulse oximetry). Abbreviations: max, maximum; ROC, receiver operating characteristic.

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