Hutchinson Ann, Pickering Alistair, Williams Paul, Bland J Martin, Johnson Miriam J
Hull York Medical School, University of Hull, Hull, HU6 7RX, UK.
HEYHT, Hull, UK.
BMC Pulm Med. 2017 Mar 20;17(1):53. doi: 10.1186/s12890-017-0396-4.
Breathlessness is a frequently occurring symptom of cardiorespiratory conditions and is a common cause of emergency department presentation. The aim of this study was to estimate the prevalence of acute-on-chronic breathlessness as a cause for presentation to the major emergencies area of the emergency department.
A prospective patient self-report survey and clinical record review of consecutive attendees to the major emergencies area of the emergency department in a single tertiary hospital between 12/5/14 and 29/5/14 was conducted. Eligible patients were clinically stable and had mental capacity to provide data.
There were 2,041 presentations during the study period, of whom 1,345 (66%) were eligible. There was a 90% survey response rate (1,212/1,345); 424/1,212 (35%) self-reported breathlessness most days over the past month of whom 245 gave breathlessness as a reason for this presentation. Therefore, the prevalence of acute-on-chronic breathlessness as a reason to present to the major emergencies area was 20.2% (245/1,212, 95% CI 17.9% to 22.5%). During this period there were 4,692 major and minor presentations; breathlessness was therefore a cause of at least 5.2% (245/4,692, 95% CI 4.6 to 5.9%) of all emergency department presentations.
This study found that one in five ambulance presentations to the ED were due to acute-on-chronic breathlessness. Most patients had non-malignant underlying conditions, had experienced considerable breathlessness for an extended period, had discussed breathlessness with their GP and presented out of daytime hours. Others were often involved in their decision to present. This represents clinically significant burden for patients, their family carers and the emergency health services.
呼吸困难是心肺疾病常见的症状，也是急诊科就诊的常见原因。本研究旨在评估以急性加重慢性呼吸困难为原因前往急诊科主要急诊区域就诊的患病率。
对一家三级医院在2014年5月12日至2014年5月29日期间前往急诊科主要急诊区域的连续就诊患者进行前瞻性患者自我报告调查和临床记录回顾。符合条件的患者临床状况稳定且有能力提供数据。
研究期间共有2041人次就诊，其中1345人（66%）符合条件。调查回复率为90%（1212/1345）；在过去一个月中，1212人中有424人（35%）自我报告大多数日子有呼吸困难，其中245人将呼吸困难作为此次就诊的原因。因此，以急性加重慢性呼吸困难为原因前往主要急诊区域就诊的患病率为20.2%（245/1212，95%置信区间为17.9%至22.5%）。在此期间，共有4692人次主要和次要就诊；因此，呼吸困难是所有急诊科就诊病例中至少5.2%（245/4692，95%置信区间为4.6%至5.9%）的原因。
本研究发现，五分之一的救护车送往急诊科的病例是由于急性加重慢性呼吸困难。大多数患者有非恶性基础疾病，长期经历严重呼吸困难，曾与全科医生讨论过呼吸困难问题，且在白天以外的时间就诊。其他人通常参与了他们就诊的决定。这对患者、其家庭护理人员和紧急医疗服务来说是临床上的重大负担。
