Feasibility of a structured 3-minute walk test as a clinical decision tool for patients presenting to the emergency department with acute dyspnoea.
BACKGROUND
Emergency department (ED) physicians face frequent decisions on whether to admit patients with congestive heart failure (CHF) or acute exacerbation of chronic obstructive pulmonary disease (COPD). This feasibility study evaluated the potential of a structured 3-minute walk test as a clinical decision tool for admission and correlated its performance with poor clinical outcomes. It also aimed to gather evidence and directions for the design of a multicentre study to derive clinical guidelines.


METHODS
In this prospective cohort study, a convenience sample was enrolled of 40 adult patients who presented to a tertiary care ED with CHF, COPD, or stable chest pain and were being considered for discharge. Patients walked at their own pace and their dyspnoea, respiratory rate, heart rate and oxygen saturation were recorded each minute for 4 minutes. The primary outcome was "poor clinical outcome" defined as admission to hospital, the need for biphasic positive airway pressure, the need for intubation, relapse, or death.


RESULTS
85.0% successfully completed the test and 30.0% had poor clinical outcomes. Of those with poor clinical outcomes, 41.7% were unable to complete the test compared with only 3.6% of those with good clinical outcomes (p<0.01). Significant differences were noted in the dyspnoea (p = 0.04) and respiratory rate (p = 0.03) as well as oxygen saturation measurements at 3 minutes.


CONCLUSIONS
The 3-minute walk test is a non-resource intensive, simple procedure with applicability in most ED for discharge decisions in patients with cardiopulmonary conditions. Multicentre studies are being planned to validate these findings and establish guidelines for admission and discharge of patients with CHF or acute exacerbation of COPD.
Pan
A M
AM
Clinical Epidemiology Unit, Ottawa Health Research Institute, The Ottawa Hospital, Ottawa, Canada.
Stiell
I G
IG
Clement
C M
CM
Acheson
J
J
Aaron
S D
SD
D000368:Aged; D000369:Aged, 80 and over; D003661:Decision Support Techniques; D004417:Dyspnea / Q000175:diagnosis* / Q000209:etiology; D004636:Emergency Service, Hospital; D004812:Epidemiologic Methods; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000150:complications; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D010351:Patient Discharge; D018579:Patient Selection; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications