Studies of the symptom dyspnoea: A systematic review

Abstract

BackgroundTo deal with patients suffering from dyspnoea, it is crucial for general practitioners to know the prevalences of different diseases causing dyspnoea in the respective area and season, the likelihood of avoidable life-threatening conditions and of worsening or recovery from disease.AimAim of our project was to conduct a systematic review of symptom-evaluating studies on the prevalence, aetiology, and prognosis of dyspnoea as presented to GPs in a primary care setting.MethodsWe did a systematic review of symptom-evaluating studies on dyspnoea in primary care. For this we included all studies investigating the complaint “dyspnoea” as a primary or secondary consulting reason in general practice. Apart from qualitative studies, all kind of study designs independent from type of data assessment, outcome measurement or study quality were included. Symptom-evaluating studies from other settings than primary care and studies which exclusively included children (age <18 years) were excluded from the review. Studies selecting patients prior to recruitment, e.g. because of an increased probability for a particular diagnosis, were also excluded.ResultsThis systematic review identified 6 symptom evaluating studies on dyspnoea in the primary care setting. The prevalence of dyspnoea as reason for consultation ranges from 0.87 to 2.59 % in general practice. Among all dyspnoea patients 2.7 % (CI 2.2–3.3) suffer from pneumonia. Further specification of underlying aetiologies seems difficult due to the studies’ heterogeneity showing a great variety of probabilities.ConclusionThere is a great lack of empirical evidence on the prevalence, aetiology and prognosis of dyspnoea in general practice. This might yield uncertainty in diagnosis and evaluation of dyspnoea in primary care.

The frequency and outcome of acute dyspnoea in primary care: An observational study

“…[12] The reason for this is unknown. Most of the contacts occurred at the surgery (83%), similar to the 91.1 % in Viniol's study, [11] except for patients above age 90. This seems logical since these patients are usually less mobile or present conditions making them unable to go to the surgery.…”

“…[10,11] Another strength of the study is that it produces some evidence about predictors and also about most frequent diagnoses in people complaining of acute dyspnoea, while other studies could not produce such details. [11] However, the study had several limitations. First, the statistical power of this study was limited as the number of patients with dyspnoea was limited.…”

“…[10] A 2011 observational study of 8877 patients (adults presenting with acute dyspnoea in primary care in Saxon, Germany) found that emergency cases were rare in the general practitioner's consultation and that the majority of underlying causes were acute respiratory infections and exacerbations of previously known chronic diseases. [2] A recent study by Viniol et al [11] reported that except for pneumonia, further specification of underlying aetiologies seems difficult due to the between-study heterogeneity; they confirmed that there is still a lack of evidence on the prevalence and causes of dyspnoea.…”

Prevalence, aetiologies and prognosis of the symptom dizziness in primary care – a systematic review

“…To our knowledge, no tools exist yet to assess the risk of bias in symptom evaluating studies. Therefore, we developed a standardized tool, based on the sparse methodological literature [ 7 , 8 ] and own previous experience in the area [ 9 , 10 ]. Two reviewers (SS and KH) independently answered signal questions and assessed the risk of bias separately for four key domains: selection of patients and GPs, data collection and patient flow, determination of the underlying aetiology, and determination of the prognosis.…”

Accuracy of the general practitioner’s sense of alarm when confronted with dyspnoea and/or chest pain: a prospective observational study

“…GPs consider all these diagnoses when confronted with the often non-specific symptoms of dyspnoea and chest pain 1. Dyspnoea represents a reason for consultation in 0.9%–2.6% of cases in primary care,2–6 and is even the fourth reason for consultation by older patients 7. Chest pain represents from 0.7% to 2.7% of patient consultations in general practice 3 6 8 9.…”