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GPs go forth

GPs 'should not use breathlessness score over phone to assess Covid-19'

A clinical scoring system being used to assess breathlessness in potential Covid-19 patients ‘is not considered to have the necessary reliability by itself’ and should not be used, the RCGP has warned.

GPs have been using the Roth score during remote assessment of patients who may have the virus after it was initially cautiously recommended by academics and it was widely circulated on social media - but without the caveats.

The academics said they also believed it had been incorporated into local and national guidelines.

But the University of Oxford team, who originally recommended the score and who have been working with the RCGP to produce guidelines on assessing breathlessness, now say the scoring system should not be used due to the lack of evidence behind it.

They warned they had received reports of significant events in which deteriorating patients were falsely reassured because of a ‘normal’ Roth score.

In the group’s new set of guidelines, it said: ‘There are no validated tests for assessing breathlessness over the phone in an acute primary care setting.’

Instead, the experts recommend an overall clinical assessment, including questions about the rate of change in a patient’s breathlessness.

The Roth score is a tool designed for quantifying a patient’s level of breathlessness. Patients are instructed to count from one to 30 in a single exhalation. This is combined with the 'counting time' – the time taken to reach the maximum count.

The score has been subjected to only one, small validation study of just 93 people in hospital in Israel - none with Covid-19 - with a control group of 103 healthy people.

The findings showed the Roth score correlated to hypoxia, but ‘do not show that the test is either valid or safe’, said the academics.

Even under the conditions of the study, the Roth score was found to wrongly classify one hypoxic patient in five as normal, they warned.

They added: ‘In the context of a Covid pandemic, this would lead to such patients being sent to a ‘hot hub’ or a hospital unnecessarily, thereby exposing them to the risk of contagion.’

In a statement, the RCGP said: ‘The Royal College of GPs has been working with University of Oxford regarding developing guidelines for general practitioners during the Covid-19 outbreak.

‘The Roth score was initially thought to be a useful approach to assessing patients remotely. However upon further analysis, it is not considered to have the necessarily reliability by itself.’

Readers' comments (4)

  • Like everything in Primary care, the Roth score s is a tool rather than a rule- exactly the same logic applies to NEWS and PEWS score which have slipped into widespread practice

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  • Exactly - it can be a useful guide, alongside history, symptoms and clinical judgement and intuition but of course nothing is failsafe!

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  • Even Sats unreliable as a single asessment with many descriptions from our intensivist colleagues of episodes of rapid desaturation, some symptomatic and some not.

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  • one patienthad got himself an oxygen meter. it was 94% when I rang him--when good was 97%.
    I told him to seek help if more breathless and if O2 drops to 90 or below.

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