title: Prevalence and Predictive Value of Dyspnea Ratings in Hospitalized Patients: Pilot Studies.
abstract: BACKGROUND
  Dyspnea (breathing discomfort) can be as powerfully aversive as pain, yet is not routinely assessed and documented in the clinical environment. Routine identification and documentation of dyspnea is the first step to improved symptom management and it may also identify patients at risk of negative clinical outcomes.
  
  
  OBJECTIVE
  To estimate the prevalence of dyspnea and of dyspnea-associated risk among hospitalized patients.
  
  
  METHODS
  Two pilot prospective cohort studies.
  
  
  METHODS
  Single academic medical center.
  
  
  METHODS
  Consecutive patients admitted to four inpatient units: cardiology, hematology/oncology, medicine, and bariatric surgery.
  
  
  METHODS
  In Study 1, nurses documented current and recent patient-reported dyspnea at the time of the Initial Patient Assessment in 581 inpatients. In Study 2, nurses documented current dyspnea at least once every nursing shift in 367 patients. We describe the prevalence of burdensome dyspnea, and compare it to pain. We also compared dyspnea ratings with a composite of adverse outcomes: 1) receipt of care from the hospital's rapid response system, 2) transfer to the intensive care unit, or 3) death in hospital. We defined burdensome dyspnea as a rating of 4 or more on a 10-point scale.
  
  
  RESULTS
  Prevalence of burdensome current dyspnea upon admission (Study 1) was 13% (77 of 581, 95% CI 11%-16%). Prevalence of burdensome dyspnea at some time during the hospitalization (Study 2) was 16% (57 of 367, 95% CI 12%-20%). Dyspnea was associated with higher odds of a negative outcome.
  
  
  CONCLUSIONS
  In two pilot studies, we identified a significant symptom burden of dyspnea in hospitalized patients. Patients reporting dyspnea may benefit from a more careful focus on symptom management and may represent a population at greater risk for negative outcomes.
authors.affiliation: Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America.|Department of Medicine, Division for Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America.|Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Jennifer P
authors.initials: JP
authors.lastname: Stevens
authors.affiliation: Department of Nursing, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America.
authors.forename: Kathy
authors.initials: K
authors.lastname: Baker
authors.affiliation: Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, Illinois, United States of America.|Center for Healthcare Delivery Science and Innovation, University of Chicago, Chicago, Illinois, United States of America.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Howell
authors.affiliation: Department of Medicine, Division for Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America.|Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Banzett
mesh_terms: D000368:Aged; D004417:Dyspnea / Q000453:epidemiology*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007297:Inpatients; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015995:Prevalence; D011446:Prospective Studies; D012306:Risk