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

Kelly, Anne; Keijzers, Gerben; Klim, Sharon; Graham, Colin A.; Craig, Simon; Kuan, Win Sen; Jones, P. G.; Holdgate, Anna; Lawoko, Charles; Laribi, Sai͏̈d; Cowell, David Lord; Jain, Nitin; Villecourt, Tracey L de; Lee, Kendall; Chalkley, Dane; Lozzi, Lydia; Asha, Stephen Edward; Duffy, Martin; Watkins, Gina; Rosengren, David; Thone, Jae; Martin, Shane P.; Orda, Ulrich; Thom, Ogilvie; Kinnear, Frances; Watson, Michael Craig; Eley, Robert; Ryan, Alison; Morel, Douglas; Furyk, Jeremy; Smith, Richard; Grummisch, Michelle; Meek, Robert; Rosengarten, Pamela; Chan, Barry; Haythorne, Helen; Archer, Peter; Wilson, Kathryn M.; Knott, Jonathan; Ritchie, Peter; Bryant, M. G.; MacDonald, Stephen; Mahlangu, Mlungisi; Scott, Michael J.; Cheri, Thomas; Nguyen, Mai; Chor, Melvin S. Y.; Wong, Chi Pang; Wong, Tai Wai; Leung, Ling‐Pong; Man, Chan Ka; Rahman, Nik Hisamuddin Nik Ab; Lee, Wee Yee; Lee, Francis Chun Yue; Goh, Shaun E.; Russell, Kerrie

doi:10.1111/acem.13118

Cited by 70 publications

(88 citation statements)

References 15 publications

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“…Patients with an ED diagnosis of AECOPD made up 0.7% (95% CI: 0.6-0.8%) of all ED attendances during the study period and 13.6% (12.5-14.9%) of the cohort of patients presenting with dyspnoea. 7 Sixty-five percent of patients arrived at ED by ambulance. Demographic features and co-morbidity are summarized in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…Patients with an ED primary diagnosis of AECOPD make up a significant proportion of ED caseload; a similar proportion to heart failure (15%) and asthma (12.7%). 7 They usually arrive by ambulance, have significant co-morbidities, more than three quarters require hospital admission and in-hospital mortality is 4%. Overall, the regional cohorts were well matched for demographics and co-morbidity, although it is notable that the smoking rate was significantly lower in SEA and cardiac failure was more common in ANZ.…”

Section: Discussionmentioning

confidence: 99%

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Epidemiology, treatment, disposition and outcome of patients with acute exacerbation of COPD presenting to emergency departments in Australia and South East Asia: An AANZDEM study

et al. 2018

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Epidemiology, treatment, disposition and outcome of patients with acute exacerbation of COPD presenting to emergency departments in Australia and South East Asia: An AANZDEM study

et al. 2018

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“…Shortness of breath is a common reason for patients to attend an ED . Patients with dyspnoea make up approximately 5% of all adult ED attendances, but importantly result in over 11% of ward admissions and nearly 20% of intensive care unit (ICU) admissions . Research suggests that an acute exacerbation of asthma is responsible for approximately 13% of adult patients presenting to the ED with dyspnoea …”

Section: Introductionmentioning

confidence: 99%

“…1 Patients with dyspnoea make up approximately 5% of all adult ED attendances, but importantly result in over 11% of ward admissions and nearly 20% of intensive care unit (ICU) admissions. 2 Research suggests that an acute exacerbation of asthma is responsible for approximately 13% of adult patients presenting to the ED with dyspnoea. 2 The initial management of an exacerbation of asthma is well-established and described in several guidelines including those of the National Asthma Council (Australia), Global Initiative for Asthma, the British Thoracic Society and the Scottish Intercollegiate Guidelines Network.…”

Section: Introductionmentioning

confidence: 99%

“…2 Research suggests that an acute exacerbation of asthma is responsible for approximately 13% of adult patients presenting to the ED with dyspnoea. 2 The initial management of an exacerbation of asthma is well-established and described in several guidelines including those of the National Asthma Council (Australia), Global Initiative for Asthma, the British Thoracic Society and the Scottish Intercollegiate Guidelines Network. [3][4][5][6] These guidelines agree that initial management should include assessment of severity, administration of short-acting beta-agonists (SABAs), titrated oxygen therapy and administration of systemic corticosteroids.…”

Section: Introductionmentioning

confidence: 99%

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Treatment and outcome of adult patients with acute asthma in emergency departments in Australasia, South East Asia and Europe: Are guidelines followed? AANZDEM/EuroDEM study

Craig

Kuan

Kelly

et al. 2019

Emerg Medicine Australasia

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Objective Asthma exacerbations are common presentations to ED. Key guideline recommendations for management include administration of inhaled bronchodilators, systemic corticosteroids and titrated oxygen therapy. Our aim was to compare management and outcomes between patients treated for asthma in Europe (EUR) and South East Asia/Australasia (SEA) and compliance with international guidelines. Methods In each region, prospective, interrupted time series studies were performed including adult (age >18 years) patients presenting to ED with the main complaint of dyspnoea during three 72 h periods. This was a planned sub‐study that included those with an ED primary diagnosis of asthma. Data was collected on demographics, clinical features, treatment in ED, diagnosis, disposition and in‐hospital outcome. The results of interest were differences in treatment and outcome between EUR and SEA cohorts. Results Five hundred and eighty‐four patients were identified from 112 EDs (66 EUR and 46 SEA). The cohorts had similar demographics and co‐morbidity patterns, with 89% of the cohort having a previous diagnosis of asthma. There were no significant differences in treatment between EUR and SEA patients – inhaled beta‐agonists were administered in 86% of cases, systemic corticosteroids in 66%, oxygen therapy in 44% and antibiotics in 20%. Two thirds of patients were discharged home from the ED. Conclusion The data suggests that compliance with guideline‐recommended therapy in both regions, particularly corticosteroid administration, is sub‐optimal. It also suggests over‐use of antibiotics.

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Predicting outcome for ambulance patients with dyspnea: a prospective cohort study

et al. 2020

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Objective To validate the discrimination and classification accuracy of a novel acute dyspnea scale for identifying outcomes of out‐of‐hospital patients with acute dyspnea. Methods Prospective observational population‐based study in the North Denmark Region. We included patients from July 1, 2017 to September 24, 2019 assessed as having acute dyspnea by the emergency dispatcher or by emergency medical services (EMS) personnel. Patients rated dyspnea using the 11‐point acute dyspnea scale. The primary outcomes were hospitalization >2 days, ICU admission within 48 hours of ambulance run, and 30‐day mortality. We used 5‐fold cross‐validation and area under receiver operating curves (AUC) to assess predictive properties of the acute dyspnea scale score alone and combined with vital data, age, and sex. Results We included 3144 EMS patients with reported dyspnea. Median acute dyspnea scale score was 7 (interquartile range 5 to 8). The outcomes were: 1966 (63%) hospitalized, 164 (5%) ICU stay, and 224 (9%) died within 30 days of calling the ambulance. The acute dyspnea scale score alone showed poor discrimination for hospitalization (AUC 0.56, 95% confidence intervals: 0.54–0.58), intensive care unit admission (0.58, 0.53–0.62), and mortality (0.46, 0.41–0.50). Vital signs (respiratory rate, blood oxygen saturation, blood pressure, and heart rate) showed similarly poor discrimination for all outcomes. The combination of [vital signs + acute dyspnea scale score] showed better discrimination for hospitalization, ICU admission, and mortality (AUC 0.71–0.72). Patients not able to report an acute dyspnea scale score worse outcomes on all parameters. Conclusion The dyspnea scale showed poor accuracy and discrimination when predicting hospitalization, stay at intensive care unit, and mortality on its own. However, the dyspnea scale may be beneficial as performance measure and indicator of out‐of‐hospital care.

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

Abstract: 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.

Cited by 70 publications

References 15 publications

Epidemiology, treatment, disposition and outcome of patients with acute exacerbation of COPD presenting to emergency departments in Australia and South East Asia: An AANZDEM study

Epidemiology, treatment, disposition and outcome of patients with acute exacerbation of COPD presenting to emergency departments in Australia and South East Asia: An AANZDEM study

Treatment and outcome of adult patients with acute asthma in emergency departments in Australasia, South East Asia and Europe: Are guidelines followed? AANZDEM/EuroDEM study

Predicting outcome for ambulance patients with dyspnea: a prospective cohort study

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