How well do patients and providers agree on the severity of dyspnea?

Stefan, Mihaela; Priya, Aruna; Martin, Bernice M.; Pekow, Penelope S.; Rothberg, Michael B.; Goldberg, Robert J.; DiNino, Ernest; Lindenauer, Peter K.

doi:10.1002/jhm.2600

Cited by 18 publications

(13 citation statements)

References 31 publications

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“…The study found the patients themselves reported higher dyspnoea scores than the nurses and physicians perceived they experienced. Likewise, a study from the United States of America also had patients and health care professionals assess the patients' perceived dyspnoea, and found poor agreement between the two [15]. These studies emphasise the need for the patient's own assessment, dyspnoea is a devastating symptom and the ability to detect relief is essential.…”

Section: Discussionmentioning

confidence: 99%

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Patient experience of severe acute dyspnoea and relief during treatment in ambulances: a prospective observational study

Weinreich

Lübcke²,

Kløjgaard

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background: Acute dyspnoea is common among ambulance patients, but little is known of the patients' experience of symptom. We aimed to investigate ambulance patients initial perceived intensity of acute dyspnoea, and whether they experienced relief during prehospital treatment. Furthermore, to investigate the validity and feasibility of using a subjective dyspnoea score in the ambulance, and its association with objectively measured vital signs. Methods: We performed a prospective observational study in the North Denmark Region from 1. July 2017 to 30. March 2019. We studied patients over the age of 18 to whom an ambulance was dispatched. Patients with acute dyspnoea assessed either at the emergency call or by ambulance professionals on scene were included. Patients were asked to assess dyspnoea on a 0 to 10 verbal numeric rating scale at the primary contact with the ambulance personnel and immediately before release at the scene or arrival at the hospital. Patients received usual prehospital medical treatment. We used visual inspection and Wilcoxon matched-pairs signed-ranks test, to assess dyspnoea scores and change hereof. Scatterplots and linear regression analyses were used to assess associations between the dyspnoea score and vital signs. Results: We included 3199 patients with at least one dyspnoea score. Of these, 2219 (69%) had two registered dyspnoea scores. The initial median dyspnoea score for all patients was median 8 (interquartile range 6-10). In 1676 (76%) of patients with two scores, the first score decreased from 8 (6-9) to 4 (2-5) during prehospital treatment. The score was unchanged for 370 (17%) and increased for 51 (2%) patients. Higher respiratory rate, blood pressure, and heart rate was seen with higher dyspnoea scores whereas blood oxygen saturation lowered.

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Section: Discussionmentioning

confidence: 99%

“…oxygen saturation, and the degree of dyspnoea [11][12][13]. Furthermore, previous studies have suggested there is poor correlation between health care professionals' and patient's assessment of dyspnoea intensity [14,15].…”

Section: Introductionmentioning

confidence: 99%

Patient experience of severe acute dyspnoea and relief during treatment in ambulances: a prospective observational study

Weinreich

Lübcke²,

Kløjgaard

et al. 2020

Scand J Trauma Resusc Emerg Med

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“…For a variety of pathologies, from psoriasis and rheumatoid arthritis to urinary symptoms, endometriosis, and depression, numerous studies have identified significant discordance in patient and physician perceptions of disease severity ( 21 – 27 ). In surgical patients, the literature is more limited.…”

Section: Introductionmentioning

confidence: 99%

Severity of Postoperative Complications From the Perspective of the Patient

Rendell¹,

Siy²,

Stafford³

et al. 2019

Journal of Patient Experience

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Background: Although provider-derived surgical complication severity grading systems exist, little is known about the patient perspective. Objective: To assess patient-rated complication severity and determine concordance with existing grading systems. Methods: A survey asked general surgery patients to rate the severity of 21 hypothetical postoperative events representing grades 1 to 5 complications from the Accordion Severity Grading System. Concordance with the Accordion scale was examined. Separately, descriptive ratings of 18 brief postoperative events were ranked. Results: One hundred sixty-eight patients returned a mailed survey following their discharge from a general surgery service. Patients rated grade 4 complications highest. Grade 1 complications were rated similarly to grade 5 and higher than grades 2 and 3 ( P ≤ .01). Patients rated one event not considered an Accordion scale complication higher than all but grade 4 complications ( P < .001). The brief events also did not follow the Accordion scale, other than the grade 6 complication ranking highest. Conclusion: Patient-rated complication severity is discordant with provider-derived grading systems, suggesting the need to explore important differences between patient and provider perspectives.

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“…Personal caregivers’ ratings of dyspnea agreed well with the patients’ own ratings, but this was far from being the case for the nurses’ ratings. The poor aptitude of nurses, physiotherapists, and physicians in identifying dyspnea in their patients has been described before (11–13), but this is the first time that a comparison has been conducted with the corresponding aptitude of personal caregivers, who, notably, never failed to detect dyspnea.…”

mentioning

confidence: 77%