An Observational Study of Dyspnea in Emergency Departments: The Asia, Australia, and New Zealand Dyspnea in Emergency Departments Study (AANZDEM). (March 2017)

• Record Type: Journal Article
• Authors: Kelly, Anne Maree; Keijzers, Gerben; Klim, Sharon; Graham, Colin A.; Craig, Simon; Kuan, Win Sen; Jones, Peter; Holdgate, Anna; Lawoko, Charles; Laribi, Said
• Editors: Mark Courtney, D.; Mark Courtney, D.
• Other Names: Cowell David Lord investigator.; Jain Nitin investigator.; De Villecourt Tracey investigator.; Lee Kendall investigator.; Chalkley Dane investigator.; Lozzi Lydia investigator.; Asha Stephen Edward investigator.; Duffy Martin investigator.; Watkins Gina investigator.; Rosengren David investigator.; Thone Jae investigator.; Martin Shane investigator.; Orda Ulrich investigator.; Thom Ogilvie investigator.; Kinnear Frances investigator.; Watson Michael investigator.; Eley Rob investigator.; Ryan Alison investigator.; Morel Douglas Gordon investigator.; Furyk Jeremy investigator.; Smith Richard D. B. investigator.; Grummisch Michelle investigator.; Meek Robert investigator.; Rosengarten Pamela investigator.; Chan Barry investigator.; Haythorne Helen investigator.; Archer Peter investigator.; Wilson Kathryn investigator.; Knott Jonathan investigator.; Ritchie Peter investigator.; Bryant Michael investigator.; MacDonald Stephen investigator.; Mahlangu Mlungisi investigator.; Scott Michael investigator.; Cheri Thomas investigator.; Nguyen Mai investigator.; Chor Melvin S. Y. investigator.; Wong Chi Pang investigator.; Wong Tai Wai investigator.; Leung Ling‐Pong investigator.; Man Chan Ka investigator.; Rahman Nik Hisamuddin investigator.; Lee Wee Yee investigator.; Lee Francis Chun Yue investigator.; Goh Shaun E. investigator.; Russell Kerrie investigator.;
• Is Part Of: Academic emergency medicine. Volume 24:Number 3(2017)
• Page Start: 328
• Page End: 336
• Publication Date: 2017-03
• Subjects: Emergency medicine -- Periodicals; 616.02505
• DOI: 10.1111/acem.13118
• Languages: English
• ISSNs: 1069-6563

Abstract

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.