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

OBJECTIVES: To describe the epidemiology of dyspnoea presenting to emergency departments (EDs) in the Asia-Pacific region, to understand how it is investigated and treated and its outcome.

METHODS: Prospectiveinterrupted 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 dyspnoea as a main symptom. Data were collected over three 72-hour periods and included demographics, co-morbidities, mode of arrival, usual medications, pre-hospital 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 dyspnoea.

RESULTS: 3044 patients were studied. Patients with dyspnoea made up 5.2% (3105/60059, 95% CI 5.0-5.4%) of ED presentations, 11.4% of ward admissions (1956/17184, 95% CI 10.9-11.9%) and 19.9% of Intensive Care Unit (ICU) admissions (104/523, 95% CI 16.7-23.5%). 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 62-66%) with 3.3% (95% CI 2.8-4.1%) requiring ICU admission. In hospital mortality was 6% (95% CI 5.0-7.2%).

CONCLUSION: Dyspnoea 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. This article is protected by copyright. All rights reserved.