Anne Maree Kelly1,2, Gerben Keijzers3,4,5, Sharon Klim1, Colin A Graham6, Simon Craig7,8,9, Win Sen Kuan10, Peter Jones11, Anna Holdgate12, Charles Lawoko13, Said Laribi14. 1. Joseph Epstein Centre for Emergency Medicine Research @ Western Health, Sunshine Hospital, Parkville, Australia. 2. Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia. 3. Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, QLD, Australia. 4. School of Medicine, Bond University, Gold Coast, QLD, Australia. 5. School of Medicine, Griffith University, Gold Coast, QLD, Australia. 6. Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR. 7. Emergency Department, Monash Medical Centre, Clayton, Australia. 8. School of Clinical Sciences, Monash University, Clayton, Australia. 9. Murdoch Children's Research Institute, Parkville, Australia. 10. Emergency Medicine Department, National University Health System and the Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. 11. Department of Emergency Medicine, Auckland City Hospital, Auckland, New Zealand. 12. Department of Emergency Medicine, Liverpool Hospital and the University of New South Wales (Southwest Clinical School), Sydney, Australia. 13. Statistical Consulting Service, Graduate Research Centre, Victoria University, Footscray, Australia. 14. Emergency Medicine Department, Tours University Hospital (SL), Tours, France.
Abstract
OBJECTIVES: The objective was to describe the epidemiology of dyspnea presenting to emergency departments (EDs) in the Asia-Pacific region, to understand how it is investigated and treated and its outcome. METHODS: Prospective interrupted time series cohort study conducted at three time points in EDs in Australia, New Zealand, Singapore, Hong Kong, and Malaysia of adult patients presenting to the ED with dyspnea as a main symptom. Data were collected over three 72-hour periods and included demographics, comorbidities, mode of arrival, usual medications, prehospital treatment, initial assessment, ED investigations, treatment in the ED, ED diagnosis, disposition from ED, in-hospital outcome, and final hospital diagnosis. The primary outcomes of interest are the epidemiology, investigation, treatment, and outcome of patients presenting to ED with dyspnea. RESULTS: A total of 3,044 patients were studied. Patients with dyspnea made up 5.2% (3,105/60,059, 95% confidence interval [CI] = 5.0% to 5.4%) of ED presentations, 11.4% of ward admissions (1,956/17,184, 95% CI = 10.9% to 11.9%), and 19.9% of intensive care unit (ICU) admissions (104/523, 95% CI = 16.7% to 23.5%). The most common diagnoses were lower respiratory tract infection (20.2%), heart failure (14.9%), chronic obstructive pulmonary disease (13.6%), and asthma (12.7%). Hospital ward admission was required for 64% of patients (95% CI = 62% to 66%) with 3.3% (95% CI = 2.8% to 4.1%) requiring ICU admission. In-hospital mortality was 6% (95% CI = 5.0% to 7.2%). CONCLUSION: Dyspnea is a common symptom in ED patients contributing substantially to ED, hospital, and ICU workload. It is also associated with significant mortality. There are a wide variety of causes however chronic disease accounts for a large proportion.
OBJECTIVES: The objective was to describe the epidemiology of dyspnea presenting to emergency departments (EDs) in the Asia-Pacific region, to understand how it is investigated and treated and its outcome. METHODS: Prospective interrupted time series cohort study conducted at three time points in EDs in Australia, New Zealand, Singapore, Hong Kong, and Malaysia of adultpatients presenting to the ED with dyspnea as a main symptom. Data were collected over three 72-hour periods and included demographics, comorbidities, mode of arrival, usual medications, prehospital treatment, initial assessment, ED investigations, treatment in the ED, ED diagnosis, disposition from ED, in-hospital outcome, and final hospital diagnosis. The primary outcomes of interest are the epidemiology, investigation, treatment, and outcome of patients presenting to ED with dyspnea. RESULTS: A total of 3,044 patients were studied. Patients with dyspnea made up 5.2% (3,105/60,059, 95% confidence interval [CI] = 5.0% to 5.4%) of ED presentations, 11.4% of ward admissions (1,956/17,184, 95% CI = 10.9% to 11.9%), and 19.9% of intensive care unit (ICU) admissions (104/523, 95% CI = 16.7% to 23.5%). The most common diagnoses were lower respiratory tract infection (20.2%), heart failure (14.9%), chronic obstructive pulmonary disease (13.6%), and asthma (12.7%). Hospital ward admission was required for 64% of patients (95% CI = 62% to 66%) with 3.3% (95% CI = 2.8% to 4.1%) requiring ICU admission. In-hospital mortality was 6% (95% CI = 5.0% to 7.2%). CONCLUSION:Dyspnea is a common symptom in ED patients contributing substantially to ED, hospital, and ICU workload. It is also associated with significant mortality. There are a wide variety of causes however chronic disease accounts for a large proportion.
Authors: Ann Hutchinson; Alistair Pickering; Paul Williams; J Martin Bland; Miriam J Johnson Journal: BMC Pulm Med Date: 2017-03-20 Impact factor: 3.317
Authors: Gerben Keijzers; Anne-Maree Kelly; Louise Cullen; Sharon Klim; Colin A Graham; Simon Craig; Win Sen Kuan; Peter Jones; Anna Holdgate; Charles Lawoko; Said Laribi Journal: BMJ Open Date: 2017-02-28 Impact factor: 2.692