Palliative Care · Pulmonology

Respiratory Distress Observation Scale calculator

Enter the published formula inputs below to calculate and interpret this score.

Clinical inputs

Heart rate

beats/min

Allowed range: 0–250 beats/min

Beats per minute, counted for one minute. Under 90 scores 0, 90–109 scores 1, and 110 or more scores 2.

Respiratory rate

breaths/min

Allowed range: 0–80 breaths/min

Breaths per minute, counted for one minute. 18 or under scores 0, 19–30 scores 1, and over 30 scores 2.

Restlessness

None scores 0, occasional slight movements score 1, and frequent movements score 2.

Paradoxical breathing

Accessory muscle use

None scores 0, a slight clavicular rise scores 1, and a pronounced rise scores 2.

End-expiratory gruntingNasal flaringLook of fear

Result

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Primary source

Campbell ML, Templin TN. Intensity cut-points for the Respiratory Distress Observation Scale. Palliat Med. DOI: 10.1177/0269216314564238. PMID: 25634631. Table 1 prints the scale dated 19 February 2009 and studied in Campbell ML, Templin T, Walch J, J Palliat Med 2010, PMID 20078243. Heart rate under 90 scores 0, 90–109 scores 1, and 110 or more scores 2. Respiratory rate 18 or under scores 0, 19–30 scores 1, and over 30 scores 2. Restlessness: none 0, occasional slight movements 1, frequent movements 2. Paradoxical breathing, end-expiratory grunting, nasal flaring, and a look of fear have no 1-point column: absent scores 0 and present scores 2. Accessory muscle use: none 0, slight clavicular rise 1, pronounced rise 2. The total is 0–16. A score of 0–2 suggests little or no respiratory distress. A score of 3 or higher signified moderate to severe distress and a need for palliation. The same paper states that separate moderate and severe cut-points were not established. Count heart rate and respiratory rate for one minute. (2015)

Scope: Adults at risk for dyspnea who cannot self-report. The scale is not for children, neonates, quadriplegia, or bulbar amyotrophic lateral sclerosis, and it cannot be used when a neuromuscular blocker is in effect. It does not replace a self-report when the person can give one.

Last reviewed 2026-10-17

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Professional use only

For qualified clinicians. Independently verify inputs, calculations, source guidance, and applicability before any clinical action. This calculator does not replace clinical judgment.

Source: Campbell ML, Templin TN. Intensity cut-points for the Respiratory Distress Observation Scale. Palliat Med. DOI: 10.1177/0269216314564238. PMID: 25634631. Table 1 prints the scale dated 19 February 2009 and studied in Campbell ML, Templin T, Walch J, J Palliat Med 2010, PMID 20078243. Heart rate under 90 scores 0, 90–109 scores 1, and 110 or more scores 2. Respiratory rate 18 or under scores 0, 19–30 scores 1, and over 30 scores 2. Restlessness: none 0, occasional slight movements 1, frequent movements 2. Paradoxical breathing, end-expiratory grunting, nasal flaring, and a look of fear have no 1-point column: absent scores 0 and present scores 2. Accessory muscle use: none 0, slight clavicular rise 1, pronounced rise 2. The total is 0–16. A score of 0–2 suggests little or no respiratory distress. A score of 3 or higher signified moderate to severe distress and a need for palliation. The same paper states that separate moderate and severe cut-points were not established. Count heart rate and respiratory rate for one minute. (2015)

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Clinical inputs

Heart rate (beats/min)Accepted range: 0 to 250
Respiratory rate (breaths/min)Accepted range: 0 to 80
Restlessness
Paradoxical breathing
Accessory muscle use
End-expiratory grunting
Nasal flaring
Look of fear

Primary source

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