Verbal dyspnoea score predicts emergency department departure status in patients with shortness of breath

Saracino, Amanda; Weiland, Tracey J; Jolly, Brian; Dent, Andrew W

doi:10.1111/j.1742-6723.2009.01254.x

Cited by 22 publications

(15 citation statements)

References 20 publications

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“…In our study people presenting due to breathlessness were twice as likely to be admitted as others presenting to the ED for other reasons. This increased risk is consistent with previous findings [1, 5, 7, 9]. …”

Section: Discussionsupporting

confidence: 93%

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Breathlessness and presentation to the emergency department: a survey and clinical record review

Hutchinson

Pickering²,

Williams³

et al. 2017

BMC Pulm Med

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BackgroundBreathlessness is a frequently occurring symptom of cardiorespiratory conditions and is a common cause of emergency department presentation. The aim of this study was to estimate the prevalence of acute-on-chronic breathlessness as a cause for presentation to the major emergencies area of the emergency department.MethodsA prospective patient self-report survey and clinical record review of consecutive attendees to the major emergencies area of the emergency department in a single tertiary hospital between 12/5/14 and 29/5/14 was conducted. Eligible patients were clinically stable and had mental capacity to provide data.ResultsThere were 2,041 presentations during the study period, of whom 1,345 (66%) were eligible. There was a 90% survey response rate (1,212/1,345); 424/1,212 (35%) self-reported breathlessness most days over the past month of whom 245 gave breathlessness as a reason for this presentation. Therefore, the prevalence of acute-on-chronic breathlessness as a reason to present to the major emergencies area was 20.2% (245/1,212, 95% CI 17.9% to 22.5%). During this period there were 4,692 major and minor presentations; breathlessness was therefore a cause of at least 5.2% (245/4,692, 95% CI 4.6 to 5.9%) of all emergency department presentations.ConclusionsThis study found that one in five ambulance presentations to the ED were due to acute-on-chronic breathlessness. Most patients had non-malignant underlying conditions, had experienced considerable breathlessness for an extended period, had discussed breathlessness with their GP and presented out of daytime hours. Others were often involved in their decision to present. This represents clinically significant burden for patients, their family carers and the emergency health services.

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Section: Discussionsupporting

confidence: 93%

“…Breathlessness is a feature of cardiorespiratory conditions [6] and its intensity on arrival at the ED predicts hospital admission as a post-presentation destination [7]. One clinical record review showed that a quarter of people admitted to hospital from the ED were those presenting with breathlessness [8].…”

Section: Introductionmentioning

confidence: 99%

Breathlessness and presentation to the emergency department: a survey and clinical record review

Hutchinson

Pickering²,

Williams³

et al. 2017

BMC Pulm Med

View full text Add to dashboard Cite

show abstract

“…Breathlessness is a frightening symptom that limits all aspects of life and is associated with poor clinical outcomes. People with breathlessness are more likely to be sent to the hospital from primary care, admitted to the hospital from the emergency department, experience a serious in‐hospital event, and have a poorer prognosis . The relationship between breathlessness and mortality is relevant for older adults; people aged 70 and older with breathlessness are less likely to live 2 and 10 years .…”

Section: Aim and Objectivesmentioning

confidence: 99%

Breathlessness in Elderly Adults During the Last Year of Life Sufficient to Restrict Activity: Prevalence, Pattern, and Associated Factors

Johnson

Bland

Gahbauer

et al. 2016

J American Geriatrics Society

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Objectives Breathlessness is prevalent in older people. Symptom control at the end of life is important. This study investigated relationships between age, clinical characteristics and breathlessness sufficient to have people spend at least one half a day in that month in bed or cut down on their usual activities (restricting breathlessness) during the last year of life. Design Secondary data-analysis Setting General community Participants 754 non-disabled persons, aged 70 and older. Monthly telephone interviews were conducted to determine the occurrence of restricting breathlessness. The primary outcome was the percentage of months with restricting breathlessness reported during the last year of life. Results Data regarding breathlessness were available for 548/589 (93.0%) decedents (mean age 86.7 years (range 71 to 106; males 38.8%). 311/548 (56.8%) reported restricting breathlessness at some time-point during the last year of life but no-one reported this every month. Frequency increased in the months closer to death irrespective of cause. Restricting breathlessness was associated with anxiety, (0.25 percentage point increase in months breathlessness per percentage point months reported anxiety, 95% CI 0.16 to 0.34, P<0.001), depression (0.14, 0.05 to 0.24, P=0.003) and mobility problems (0.07, 0.03 to 0.1, P<0.001). Percentage months of restricting breathlessness increased if chronic lung disease was noted at the most recent comprehensive assessment (6.62 percentage points, 95% CI 4.31 to 8.94, P<0.001), heart failure (3.34, 0.71 to 5.97, P<0.01), and ex-smoker status (3.01, 0.94 to 5.07, P=0.004), but decreased with older age (−0.19, −0.37 to −0.02, P=0.03). Conclusion Restricting breathlessness increased in this elderly population in the months preceding death from any cause. Breathlessness should be assessed and managed in the context of poor prognosis.

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“…14,15 Patients were asked, “On a scale from 0 to 10, how bad is your shortness of breath, with zero being no shortness of breath and 10 the worst shortness of breath you could ever imagine?” A trained research assistant asked the patients to rate dyspnea severity at admission, at 24 hours, 48 hours, and on the day of discharge. Usual or baseline dyspnea levels were assessed by asking “Using the same 0 to 10 scale, how would you rate your shortness of breath on a usual day before you became sick and came into the hospital?” At each assessment, the patients were not reminded of their prior score.…”

Section: Methodsmentioning

confidence: 99%

The Trajectory of Dyspnea in Hospitalized Patients

DiNino

Stefan

Priya

et al. 2016

Journal of Pain and Symptom Management

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Context The trajectory of dyspnea for patients hospitalized with acute cardiopulmonary disease, who are not terminally ill, is poorly characterized. Objectives To investigate the natural history of dyspnea during hospitalization, and examine the role that admission diagnosis, and patient factors play in altering symptom resolution. Methods Prospective cohort study of patients hospitalized for an acute cardiopulmonary condition at a large tertiary care center. Dyspnea levels and change in dyspnea score were the main outcomes of interest and were assessed at admission, 24 and 48 hours and at discharge using the verbal 0 - 10 numeric scale. Results Among 295 patients enrolled, the median age was 68 years, and the most common admitting diagnoses were heart failure (32%), chronic obstructive pulmonary disease (COPD) (39%), and pneumonia (13%). The median dyspnea score at admission was 9 (interquartile range [IQR] 7, 10); decreased to 4 (IQR 2, 7) within the first 24 hours; and subsequently plateaued at 48 hours. At discharge, the median score had decreased to 2.75 (IQR 1, 4). Compared to patients with heart failure, patients with COPD had higher median dyspnea score at baseline and admission, and experienced a slower resolution of dyspnea symptoms. After adjusting for patient characteristics, the change in dyspnea score from admission to discharge was not significantly different between patients hospitalized with congestive heart failure, COPD or pneumonia. Conclusion Most patients admitted with acute cardiopulmonary conditions have severe dyspnea on presentation, and their symptoms improve rapidly after admission. The trajectory of dyspnea is associated with the underlying disease process. These findings may help set expectations for the resolution of dyspnea symptoms in hospitalized patients with acute cardiopulmonary diseases.

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Verbal dyspnoea score predicts emergency department departure status in patients with shortness of breath

Abstract: Verbal dyspnoea score, alone and in combination with heart rate and arrival transport, can accurately predict admission. Once validated they might be useful in assessing, prioritizing and making rapid site of care decisions for breathless patients presenting to the ED.

Cited by 22 publications

References 20 publications

Breathlessness and presentation to the emergency department: a survey and clinical record review

Breathlessness and presentation to the emergency department: a survey and clinical record review

Breathlessness in Elderly Adults During the Last Year of Life Sufficient to Restrict Activity: Prevalence, Pattern, and Associated Factors

The Trajectory of Dyspnea in Hospitalized Patients

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