Epidemiology of patients presenting with dyspnea to emergency departments in Europe and the Asia-Pacific region

Laribi, Sai͏̈d; Keijzers, Gerben; Meer, Oene van; Klim, Sharon; Motiejūnaitė, Justina; Kuan, Win Sen; Body, Richard; Jones, P. G.; Karamercan, Mehmet Akif; Craig, Simon; Harjola, Veli‐Pekka; Holdgate, Anna; Golea, Adela; Graham, Colin A.; Verschuren, Franck; Capsec, Jean; Christ, Michael; Grammatico‐Guillon, Leslie; Barletta, C; Garcı́a-Castrillo, Luis; Kelly, Anne‐Maree

doi:10.1097/mej.0000000000000571

Cited by 66 publications

(60 citation statements)

References 16 publications

(6 reference statements)

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“…Hence, it is not surprising to find cardiac failure, chronic bronchitis exacerbation and respiratory tract infection ahead of dyspnoea's aetiology. Similar results were found in other studies …”

Section: Discussionsupporting

confidence: 93%

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Winter virus season impact on acute dyspnoea in the emergency department

Christiaens

Charpentier

Houzé-Cerfon

et al. 2019

Clinical Respiratory J

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Objective:To compare the epidemiology of dyspnoea presented to emergency departments (EDs) during and of winter virus season (WVS). Methods: This is a monocentric retrospective cohort study. All patients attending to the ED of the Rangueil University Hospital (Toulouse, France) for dyspnoea in September 2016 (off WVS period) and January 2017 (during WVS period) were included. The primary endpoint was the final diagnosis. The patients' medical profiles, care duration, seriousness and futures were studied as secondary endpoints. Results: A total of 395 patients were studied: 125 patients during off-peak influenza season and 270 patients during the peak influenza season. The incidence of patients attending because of dyspnoea increased significantly during WVS (4.2% of ED presentations during the off WVS period versus 8.4% during the WVS period, P < 0.001). Patients attending the ED because of dyspnoea during WVS period were significantly older with more extensive medical backgrounds and more serious diseases. Most of those patients were hospitalized (54%), and largely in the geriatrics department. Conclusion: The incidence of patients attending because of dyspnoea doubled during the WVS period, with patients who were older and had more complex histories. This time-consuming population largely requires hospitalization and may be one of the causes of the emergency department's overcrowding during epidemics. K E Y W O R D S dyspnoea, emergency department, epidemiology, Upper respiratory infection

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Section: Discussionsupporting

confidence: 93%

“…Dyspnoea is a subjective symptom and its aetiologies are polymorphic, thus it can be difficult to find a diagnosis. In Laribi et al's study, unknown diagnoses were classified with “other diagnoses” and account for 36% …”

Section: Discussionmentioning

confidence: 99%

Winter virus season impact on acute dyspnoea in the emergency department

Christiaens

Charpentier

Houzé-Cerfon

et al. 2019

Clinical Respiratory J

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“…Laribi et al [18] evaluated the epidemiology and management of dyspnoeic patients presenting to EDs in an international patient population in Europe and the Asia-Pacific region. Among 5569 patients, the most common ED diagnoses were lower respiratory tract infection (24.9%), heart failure (17.3%), COPD exacerbation (15.8%), and asthma (10.5%).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of neutrophil to lymphocyte ratio to rule out chronic obstructive pulmonary disease exacerbation from acute heart failure in the emergency department

Demirtaş

2019

Disaster Emerg Med J

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INTRODUCTION: This study was performed to determine whether neutrophil-lymphocyte ratio (NLR) optimizes the differential diagnosis of acute chronic obstructive pulmonary disease (COPD) exacerbation and acute heart failure (AHF) in patients admitting to the emergency department (ED) with dyspnoea. MATERIAL AND METHODS: The study group included 241 patients (135 males and 106 females) who were admitted to the ED with a complaint of dyspnoea between January 2016 November 2018 and were hospitalized with diagnosis of acute COPD exacerbation or AHF. RESULTS: White blood cell count, neutrophil, haemoglobin, haematocrit, NLR, and C-reactive protein values in patients with COPD exacerbation were significantly higher compared to those with AHF (p < 0.05). The largest areas under the ROC curve were obtained with NLR. The cutoff value for NLR was 9.39, with a sensitivity of 71% and a specificity of 61%. CONCLUSIONS: In conclusion, the NLR has diagnostic value to the conventional clinical assessment in patients with acute dyspnoea at ED, especially with acute COPD exacerbation requiring inpatient management. This may be an additional tool during the differential diagnosis of dyspnoea for emergency physicians in hospitals without advanced laboratory facilities.

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“…From a more clinical standpoint, the main determinant of dyspnea is the respiratory and circulatory state of the patient [52]. Altered respiratory mechanics (elevated resistance and low compliance) and altered gas exchange (hypoxemia and hypercapnia) are a clear cause of dyspnea.…”

Section: The Causes Of Dyspnea: Physiopathology and Risk Factorsmentioning

confidence: 99%

Detection and management of dyspnea in mechanically ventilated patients

Decavèle

Similowski

Demoule

2019

Current Opinion in Critical Care

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Financial support and sponsorship none Conflicts of interestMaxens Decavèle has non conflicts of interest to declare. Thomas Similowski has received grant research from Coviden, Philips, Pierre Fabre Médicaments, Air Liquide Medical Systems; he has also received personal fees from Takeda, Teva Pharma, Lungpacer Inc, Almirall France, Pierre Fabre Médicaments, Novartis, Mundipharma, Invacare, Astra Zeneca, Boehringer Ingelheim and GlaxoSmithKline. Alexandre Demoule has signed research contracts with Covidien, Maquet, Philips and Ait Liquide Santé; he has also received personal fees from Covidien, Maquet and MSD. AbstractPurpose of the review. In intensive care unit (ICU) patients, dyspnea is one of the most prominent and distressing symptom. We sought to summarize current data on the prevalence and prognostic influence of dyspnea in the ICU setting and to provide concise and useful information for dyspnea detection and management.Recent findings. As opposed to pain, dyspnea has been a neglected symptom with regard to detection and management. Many factors contribute to the pathogenesis of dyspnea. Among them, ventilator settings seem to play a major role. Dyspnea affects half of mechanically ventilated patient and causes immediate intense suffering (median dyspnea visual analog scale of 5 [4][5][6][7]). In addition, it is associated with delayed extubation and with an increased risk of intubation and mortality in those receiving noninvasive ventilation. However, one third of critically ill patients are noncommunicative, and therefore at high risk of misdiagnosis.Heteroevaluation scales based on physical and behavioral signs of respiratory discomfort are reliable and promising alternatives to self-report. Summary.Dyspnea is frequent and severe in critically ill patients. Implementation of observational scale will help physicians to access to non-communicative patient's respiratory suffering and tailor its treatment. Further studies on the prognostic impact and management strategies are needed.Over the past decade, growing attention has been given to the detection and treatment of pain in intensive care unit (ICU) patients. Interestingly, during the same period, very little attention has been given to dyspnea. Indeed, data regarding dyspnea in ICU patients are scarce and there are basically no recommendations regarding the assessment and the management of dyspnea in ICU patients. Beyond being a major source of discomfort, dyspnea shares many physiological and clinical features with pain. This should make it a major preoccupation for ICU physicians and nurses whose mission is to relieve symptoms in addition to treating disease processes. However, it might be a challenging issue in mechanically ventilated patients whose ability to communicate is limited.The objective of the present review is to provide information regarding the prevalence and the risk factors of dyspnea in mechanically ventilated ICU patients. It is also to suggest some approaches to detect, quantify and manage dyspnea in these patients.

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Epidemiology of patients presenting with dyspnea to emergency departments in Europe and the Asia-Pacific region

Abstract: Dyspnea as a symptom in the ED has high ward and ICU admission rates. A variety of causes of dyspnea were observed in this study, with chronic diseases accounting for a major proportion.

Cited by 66 publications

References 16 publications

Winter virus season impact on acute dyspnoea in the emergency department

Winter virus season impact on acute dyspnoea in the emergency department

Diagnostic value of neutrophil to lymphocyte ratio to rule out chronic obstructive pulmonary disease exacerbation from acute heart failure in the emergency department

Detection and management of dyspnea in mechanically ventilated patients

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