Respiratory distress assessment instrument
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: RDAI
Overview
The respiratory distress assessment instrument (RDAI) is an assessment scale to evaluate the severity of illness in infants.
Historical Perspective
The RDAI was developed in 1987 to measure response to treatment of bronchiolitis.[1]
Data Source for Derivation and Validation
The RDAI was tested for reliability by two of the original investigators. They reported weighted kappa of 0.9.[1]
Usage and Application of the Instrument
Recently, the construct validity of the RDAI has been challenged due to low correlation with subsequent admission to the hospital or length of stay (LOS).[2] In a study of 65 children, the intraclass correlation coefficient was 0.39 (95% CI: 0.17–0.58 [n = 65]) as measured by respiratory therapists.[2] This suggests 'poor' agreement.[3] The Children's Hospital of Wisconsin Respiratory Score (CHWRS) may better predict the need for admission.[2]
Additional alternative scales are:
- Court's scale which includes respiratory rate and assessments of retractions, adventitial sounds, skin color, and general condition.[4]
- Bronchiolitis severity score (BSS) which includes respiratory rate and assessments of wheezing, retractions and general condition.[5]
- Respiratory distress observation scale (RDOS)[6]. This rates four findings on a scale ranging from 0 to 3 so that total scores range from 0 to 12.
- Tal and modified-Tal scoring systems[7]
The Instrument
| Points | |||||
|---|---|---|---|---|---|
| 0 | 1 | 2 | 3 | 4 | |
| Wheezing | |||||
| Expiration | None | End | 1/2 | 3/4 | All |
| Inspiration | None | Part | All | ||
| Location | None | Segmental < 2 of 4 lung fields |
Diffuse > 3 of 4 lung fields |
||
| Retractions | |||||
| Supraclavicular | None | Mild | Moderate | Marked | |
| Intercostal | None | Mild | Moderate | Marked | |
| Subcostal | None | Mild | Moderate | Marked | |
References
- ↑ 1.0 1.1 Lowell DI, Lister G, Von Koss H, McCarthy P (1987). "Wheezing in infants: the response to epinephrine". Pediatrics. 79 (6): 939–45. PMID 3295741.
- ↑ 2.0 2.1 2.2 Destino L, Weisgerber MC, Soung P, Bakalarski D, Yan K, Rehborg R; et al. (2012). "Validity of respiratory scores in bronchiolitis". Hosp Pediatr. 2 (4): 202–9. PMID 24313026.
- ↑ Wrobel JS, Armstrong DG (2008). "Reliability and validity of current physical examination techniques of the foot and ankle". J Am Podiatr Med Assoc. 98 (3): 197–206. PMID 18487593.
- ↑ Court SD (1973). "The definition of acute respiratory illnesses in children". Postgrad Med J. 49 (577): 771–6. PMC 2495839. PMID 4806395.
- ↑ Wang EE, Milner RA, Navas L, Maj H (1992). "Observer agreement for respiratory signs and oximetry in infants hospitalized with lower respiratory infections". Am Rev Respir Dis. 145 (1): 106–9. doi:10.1164/ajrccm/145.1.106. PMID 1731571.
- ↑ Campbell ML (2008). "Psychometric testing of a respiratory distress observation scale". J Palliat Med. 11 (1): 44–50. doi:10.1089/jpm.2007.0090. PMID 18370892.
- ↑ McCallum GB, Morris PS, Wilson CC, Versteegh LA, Ward LM, Chatfield MD; et al. (2013). "Severity scoring systems: are they internally valid, reliable and predictive of oxygen use in children with acute bronchiolitis?". Pediatr Pulmonol. 48 (8): 797–803. doi:10.1002/ppul.22627. PMID 22949369.