Diagnosis of the cause of chronic dyspnoea in primary and tertiary care: characterizing diagnostic confidence

Abstract

In adult patients referred due to chronic dyspnoea to hospital specialist clinics, there is considerable diagnostic uncertainty about its aetiology, for both referring doctors and specialist clinics. These results demonstrate the current difficulty in diagnosing the cause of chronic dyspnoea in adults, and highlight the need for evidence-based diagnostic pathways.

Chronic dyspnoea: finding the cause to reduce mortality

“…Therefore, an unclear diagnosis at referral was 39%. This was the first primary aim of the study (22). However, the fully concordant diagnosis comparing the final diagnosis (by the specialist) with the preliminary evident diagnosis was 26% (32/122).…”

“…With the above overview, Huang et al (22) have retrospectively determined what happened to 122 consecutive subjects referred from general to specialty clinics with the complaint of chronic dyspnea, defined as dyspnea of at least 8 weeks duration. The dyspnea had to be the primary complaint of the patient, not secondary as one of many other complaints.…”

“…The only two specialty clinics referred to were either cardiology or respiratory disease. Determination of whether a diagnosis for the cause of chronic dyspnea was made was from the specialty clinic as gold standard (22).…”

“…This type of comparison has rarely been done before. Concordance between referral physician and specialist physician was the third primary aim of the study (22).…”

“…The 122 subjects with chronic dyspnea had an average age of 63±16 years (22). There were 67 (55%) females and 55 (45%) males.…”