An Observational Study of Dyspnea in Emergency Departments

The Asia, Australia, and New Zealand Dyspnea in Emergency Departments Study (AANZDEM)

Anne-Maree Kelly, Gerben Keijzers, Sharon Klim, Colin A Graham, Simon Craig, Win Sen Kuan, Peter Jones, Anna Holdgate, Charles Lawoko, Said Laribi, the AANZDEM Study Group

Research output: Contribution to journalArticleResearchpeer-review

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.

Original languageEnglish
Pages (from-to)328-336
Number of pages9
JournalAcademic Emergency Medicine
Volume24
Issue number3
DOIs
Publication statusPublished - 1 Mar 2017

Cite this

Kelly, Anne-Maree ; Keijzers, Gerben ; Klim, Sharon ; Graham, Colin A ; Craig, Simon ; Kuan, Win Sen ; Jones, Peter ; Holdgate, Anna ; Lawoko, Charles ; Laribi, Said ; the AANZDEM Study Group. / An Observational Study of Dyspnea in Emergency Departments : The Asia, Australia, and New Zealand Dyspnea in Emergency Departments Study (AANZDEM). In: Academic Emergency Medicine. 2017 ; Vol. 24, No. 3. pp. 328-336.
@article{3785bc28937546e9b32a15df7ceb7330,
title = "An Observational Study of Dyspnea in Emergency Departments: The Asia, Australia, and New Zealand Dyspnea in Emergency Departments Study (AANZDEM)",
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.",
author = "Anne-Maree Kelly and Gerben Keijzers and Sharon Klim and Graham, {Colin A} and Simon Craig and Kuan, {Win Sen} and Peter Jones and Anna Holdgate and Charles Lawoko and Said Laribi and {the AANZDEM Study Group} and Robert Meek and Pamela Rosengarten and Peter Archer and Kathryn Wilson and Kerrie Russell",
year = "2017",
month = "3",
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doi = "10.1111/acem.13118",
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Kelly, A-M, Keijzers, G, Klim, S, Graham, CA, Craig, S, Kuan, WS, Jones, P, Holdgate, A, Lawoko, C, Laribi, S & the AANZDEM Study Group 2017, 'An Observational Study of Dyspnea in Emergency Departments: The Asia, Australia, and New Zealand Dyspnea in Emergency Departments Study (AANZDEM)', Academic Emergency Medicine, vol. 24, no. 3, pp. 328-336. https://doi.org/10.1111/acem.13118

An Observational Study of Dyspnea in Emergency Departments : The Asia, Australia, and New Zealand Dyspnea in Emergency Departments Study (AANZDEM). / Kelly, Anne-Maree; Keijzers, Gerben; Klim, Sharon; Graham, Colin A; Craig, Simon; Kuan, Win Sen; Jones, Peter; Holdgate, Anna; Lawoko, Charles; Laribi, Said; the AANZDEM Study Group.

In: Academic Emergency Medicine, Vol. 24, No. 3, 01.03.2017, p. 328-336.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - An Observational Study of Dyspnea in Emergency Departments

T2 - The Asia, Australia, and New Zealand Dyspnea in Emergency Departments Study (AANZDEM)

AU - Kelly, Anne-Maree

AU - Keijzers, Gerben

AU - Klim, Sharon

AU - Graham, Colin A

AU - Craig, Simon

AU - Kuan, Win Sen

AU - Jones, Peter

AU - Holdgate, Anna

AU - Lawoko, Charles

AU - Laribi, Said

AU - the AANZDEM Study Group

AU - Meek, Robert

AU - Rosengarten, Pamela

AU - Archer, Peter

AU - Wilson, Kathryn

AU - Russell, Kerrie

PY - 2017/3/1

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N2 - 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.

AB - 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.

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DO - 10.1111/acem.13118

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VL - 24

SP - 328

EP - 336

JO - Academic Emergency Medicine

JF - Academic Emergency Medicine

SN - 1069-6563

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