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.

Design: Two pilot prospective cohort studies.

Setting: Single academic medical center.

Patients: Consecutive patients admitted to four inpatient units: cardiology, hematology/oncology, medicine, and bariatric surgery.

Measurements: 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.

Fig 1. Prevalence of patients experiencing burdensome dyspnea and pain at the time of initial patient assessment (Study 1) and at any time during the hospital stay (Study 2).

Fig 2. Three example patterns of dyspnea recorded once per nursing shift.

Patient 1 presented with a dyspnea score of 8, Patient 2 with a score of 5 and Patient 3 with a score of 1. All of these patients had a length of stay more than 8 days, longer than average. (Study 2)

Fig 3. Univariable comparisons of risk of combined negative outcome related to measurements of dyspnea.

Panel A–Pilot Study 1: (a) measurements of current dyspnea on admission and (b) measurements of exertional dyspnea prior to admission; Panel B–Pilot Study 2: (a) measurements of current dyspnea during first nursing shift and (b) measurements of any elevated dyspnea throughout the hospitalization. Error bars represent 95% confidence intervals calculated using Wald confidence limits for binomial proportions; tests of difference were performed using chi-squared tests with the exception of Pilot Study 2, upper right panel, which used Fisher’s exact test given small cell sizes.