Dyspnea Management in Patients Presenting to the Emergency Department at Cantonal Hospital Baselland-A Retrospective Observational Study and Medical Audit.

Abstract

Background/Objectives: Dyspnea, the subjective experience of breathing discomfort, accounts for approximately 5% of emergency department (ED) presentations, 10% of general ward admissions, and 20% of intensive care unit (ICU) admissions. Despite its prevalence, dyspnea remains a challenging clinical manifestation for physicians. To the best of our knowledge, there are no international guidelines for the assessment and management of patients with dyspnea coming to the ED. In this study, we aim to evaluate how dyspnea cases are assessed and managed at Cantonal Hospital Baselland in Liestal (KSBL) and to audit these practices. Methods: We conducted a retrospective, observational study of hospital records from KSBL, including all patients presenting to the ED with dyspnea as their primary symptom who were subsequently admitted to the internal medicine ward for at least one night between January and December 2022. Data on assessment and management practices were compared using the medStandards algorithm. Results: A total of 823 cases were included. The median age at admission was 76 years (with a range of 15-99), and 57% of the patients were male. Blood pressure and heart rate were documented in 93.8% of the cases, respiratory rate in 61.4%, oxygen saturation in 96.1%, and body temperature in 86.3%. The patient's subjective dyspnea description was recorded in 14.8% of the cases, while the temporal onset (timing of symptoms) was documented in 98.8%, and the intensity of effort triggering dyspnea was noted in 36.2% of cases. A dyspnea index scale was used in 7.8% and smoking status was documented in 41.1% of the cases. Lung percussion was performed in 2.6% of the cases, while a lung auscultation was performed in 94.4% and a heart auscultation was performed in 85.3% of cases. A complete blood count with a basic metabolic panel and TSH test was collected in 86.9% of the cases, while a blood gas analysis was collected in 34.0% of the cases. An ECG was reported in 87.5% of the cases. From the 337 patients who should have received an emergency ultrasound, 10.1% received one. The three most frequent final diagnoses were decompensated heart failure (28.4%), pneumonia (26.4%), and COVID-19 (17.0%). None of the three patients with a known neuromuscular disease were admitted to the shock room. Conclusions: Our findings reveal that the medStandards algorithm was only partially followed at the ED in KSBL Liestal, highlighting gaps in detailed history taking, respiratory rate measurement, lung percussion, and emergency ultrasound use. Given the frequency of dyspnea-related presentations, systematic improvements in the adherence to assessment protocols are urgently needed to enhance patient outcomes.