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Epidemiology of patients presenting with dyspnea to emergency departments in Europe and the Asia-Pacific region

Laribi, Saida,b; Keijzers, Gerbene,f,g; van Meer, Oenen; Klim, Sharonh; Motiejunaite, Justinac,d,o; Kuan, Win Senp; Body, Richardq,r; Jones, Peters; Karamercan, Mehmett,u; Craig, Simonj,k; Harjola, Veli-Pekka; Holdgate, Annai; Golea, Adela§; Graham, Colinv; Verschuren, Franckw; Capsec, Jeanb; Christ, Michaelx,y; Grammatico-Guillon, Lesliea,b; Barletta, Cinziaz; Garcia-Castrillo, Luis; Kelly, Anne-Mareel,m on behalf of the AANZDEM and EURODEM study groups

European Journal of Emergency Medicine: August 30, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/MEJ.0000000000000571
Original article: PDF Only

Objective The primary objective of this study was to describe the epidemiology and management of dyspneic patients presenting to emergency departments (EDs) in an international patient population. Our secondary objective was to compare the EURODEM and AANZDEM patient populations.

Patients and methods An observational prospective cohort study was carried out in Europe and the Asia-Pacific region. The study included consecutive patients presenting to EDs with dyspnea as the main complaint. Data were collected on demographics, comorbidities, chronic treatment, clinical signs and investigations, treatment in the ED, diagnosis, and disposition from ED.

Results A total of 5569 patients were included in the study. The most common ED diagnoses were lower respiratory tract infection (LRTI) (24.9%), heart failure (HF) (17.3%), chronic obstructive pulmonary disease (COPD) exacerbation (15.8%), and asthma (10.5%) in the overall population. There were more LRTI, HF, and COPD exacerbations in the EURODEM population, whereas asthma was more frequent in the AANZDEM population. ICU admission rates were 5.5%. ED mortality was 0.6%. The overall in-hospital mortality was 5.0%. In-hospital mortality rates were 8.7% for LRTI, 7.6% for HF, and 5.6% for COPD patients.

Conclusion Dyspnea as a symptom in the ED has high ward and ICU admission rates. A variety of causes of dyspnea were observed in this study, with chronic diseases accounting for a major proportion.

aTours University

bDepartment of Emergency Medicine, Tours University Hospital, Tours

cINSERM, U942, BIOmarkers in CArdioNeuroVAScular diseases

dDepartment of Anesthesiology and Critical Care, APHP, Saint Louis Lariboisière Hospitals, Paris, France

eDepartment of Emergency Medicine, Gold Coast University Hospital

fFaculty of Health Sciences and Medicine, Bond University

gSchool of Medicine, Griffith University, Gold Coast

hJoseph Epstein Centre for Emergency Medicine Research at Western Health, Sunshine, Queensland

iDepartment of Emergency Medicine, Liverpool Hospital, University of New South Wales (Southwest Clinical School), Sydney, New South Wales

jEmergency Department, Monash Medical Centre

kSchool of Clinical Sciences at Monash Health, Monash University, Clayton

lJoseph Epstein Centre for Emergency Medicine Research, Western Health

mDepartment of Medicine, Melbourne Medical School – Western Precinct, The University of Melbourne, St. Albans, Victoria, Australia

nLeiden University Medical Center, Leiden, the Netherlands

oDepartment of Cardiology, Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania

pDepartment of Emergency Medicine, National University Hospital, National University Health System, Singapore

qEmergency Department, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road

rCardiovascular Sciences Research Group, the University of Manchester, Manchester, England

sDepartment of Adult Emergency Medicine, Auckland City Hospital, Auckland, New Zealand

tDepartment of Emergency Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey

uDepartment of Emergency Medicine, Istanbul Bagcilar Training and Research Hospital, Istanbul, Turkey

vChinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong (SAR)

wDepartment of Acute Medicine, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium

xDepartment of Emergency Care, Luzerner Kantonsspital, Luzern, Switzerland

yParacelsus Medical University, Nuremberg, Germany

zDepartment of Emergency Medicine, St. Eugenio Hospital, Rome, Italy

Servicio Urgencias Hospital Marqués de Valdecilla, Santander, Spain

Department of Emergency Medicine and Services, Helsinki University Hospital, University of Helsinki, Helsinki, Finland

§Emergency Department of the University County Emergency Hospital, University of Medicine and Pharmacy, Cluj Napoca, Romania

Correspondence to Said Laribi, MD, PhD, Urgences – SAMU 37 – SMUR, CHRU de Tours, 37044, Tours, Cedex 9, France Tel: +33 247 478 109; fax: +33 247 473 678; e-mail:

Received June 28, 2017

Accepted July 19, 2018

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