title: An Observational Study of Dyspnea in Emergency Departments: The Asia, Australia, and New Zealand Dyspnea in Emergency Departments Study (AANZDEM).
abstract: The objective was to describe the epidemiology of dyspnea presenting to emergency departments (EDs) in the Asia-Pacific region, to understand how it is investigated and treated and its outcome.
  
  
  
  Prospective interrupted time series cohort study conducted at three time points in EDs in Australia, New Zealand, Singapore, Hong Kong, and Malaysia of adult patients presenting to the ED with dyspnea as a main symptom. Data were collected over three 72-hour periods and included demographics, comorbidities, mode of arrival, usual medications, prehospital treatment, initial assessment, ED investigations, treatment in the ED, ED diagnosis, disposition from ED, in-hospital outcome, and final hospital diagnosis. The primary outcomes of interest are the epidemiology, investigation, treatment, and outcome of patients presenting to ED with dyspnea.
  
  
  
  A total of 3,044 patients were studied. Patients with dyspnea made up 5.2% (3,105/60,059, 95% confidence interval [CI] = 5.0% to 5.4%) of ED presentations, 11.4% of ward admissions (1,956/17,184, 95% CI = 10.9% to 11.9%), and 19.9% of intensive care unit (ICU) admissions (104/523, 95% CI = 16.7% to 23.5%). The most common diagnoses were lower respiratory tract infection (20.2%), heart failure (14.9%), chronic obstructive pulmonary disease (13.6%), and asthma (12.7%). Hospital ward admission was required for 64% of patients (95% CI = 62% to 66%) with 3.3% (95% CI = 2.8% to 4.1%) requiring ICU admission. In-hospital mortality was 6% (95% CI = 5.0% to 7.2%).
  
  
  
  Dyspnea is a common symptom in ED patients contributing substantially to ED, hospital, and ICU workload. It is also associated with significant mortality. There are a wide variety of causes however chronic disease accounts for a large proportion.
authors.affiliation: Joseph Epstein Centre for Emergency Medicine Research @ Western Health, Sunshine Hospital, Parkville, Australia.|Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia.
authors.forename: Anne Maree
authors.initials: AM
authors.lastname: Kelly
authors.affiliation: Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, QLD, Australia.|School of Medicine, Bond University, Gold Coast, QLD, Australia.|School of Medicine, Griffith University, Gold Coast, QLD, Australia.
authors.forename: Gerben
authors.initials: G
authors.lastname: Keijzers
authors.affiliation: Joseph Epstein Centre for Emergency Medicine Research @ Western Health, Sunshine Hospital, Parkville, Australia.
authors.forename: Sharon
authors.initials: S
authors.lastname: Klim
authors.affiliation: Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR.
authors.forename: Colin A
authors.initials: CA
authors.lastname: Graham
authors.affiliation: Emergency Department, Monash Medical Centre, Clayton, Australia.|School of Clinical Sciences, Monash University, Clayton, Australia.|Murdoch Children's Research Institute, Parkville, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Craig
authors.affiliation: Emergency Medicine Department, National University Health System and the Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Win Sen
authors.initials: WS
authors.lastname: Kuan
authors.affiliation: Department of Emergency Medicine, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Peter
authors.initials: P
authors.lastname: Jones
authors.affiliation: Department of Emergency Medicine, Liverpool Hospital and the University of New South Wales (Southwest Clinical School), Sydney, Australia.
authors.forename: Anna
authors.initials: A
authors.lastname: Holdgate
authors.affiliation: Statistical Consulting Service, Graduate Research Centre, Victoria University, Footscray, Australia.
authors.forename: Charles
authors.initials: C
authors.lastname: Lawoko
authors.affiliation: Emergency Medicine Department, Tours University Hospital (SL), Tours, France.
authors.forename: Said
authors.initials: S
authors.lastname: Laribi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D015331:Cohort Studies; D015897:Comorbidity; D004417:Dyspnea / Q000175:diagnosis / Q000453:epidemiology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D011446:Prospective Studies; D012306:Risk; D012846:Singapore / Q000453:epidemiology