Epidemiology, treatment and outcome of patients with lower respiratory tract infection presenting to emergency departments with dyspnoea (AANZDEM and EuroDEM studies)

Geoffroy Rousseau¹, Gerben Keijzers^{2

3

4}, Oene van Meer⁵, Simon Craig^{6

7}, Mehmet Karamercan⁸, Sharon Klim⁹, Richard Body^{10

11}, Win Sen Kuan^{12

13}, Veli-Pekka Harjola^{14

15}, Peter Jones^{16

17}, Franck Verschuren¹⁸, Anna Holdgate^{19

20}, Michael Christ²¹, Adela Golea²², Jean Capsec²³, Cinzia Barletta²⁴, Colin A Graham²⁵, Luis Garcia-Castrillo²⁶, Said Laribi^{1

27}, Anne-Maree Kelly^{9

28}

Affiliations

¹ Department of Emergency Medicine, Tours University Hospital, Tours, France.
² Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia.
³ School of Medicine, Bond University, Gold Coast, Queensland, Australia.
⁴ School of Medicine, Griffith University, Gold Coast, Queensland, Australia.
⁵ Emergency Department, Leiden University Medical Center, Leiden, The Netherlands.
⁶ Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia.
⁷ School of Clinical Sciences, Monash Health, Monash University, Melbourne, Victoria, Australia.
⁸ Department of Emergency Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey.
⁹ Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, Victoria, Australia.
¹⁰ Emergency Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
¹¹ Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK.
¹² Department of Emergency Medicine, National University Health System, Singapore.
¹³ Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
¹⁴ Emergency Medicine, University of Helsinki, Helsinki, Finland.
¹⁵ Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland.
¹⁶ Emergency Department, Auckland City Hospital, Auckland, New Zealand.
¹⁷ Department of Surgery, The University of Auckland, Auckland, New Zealand.
¹⁸ Department of Acute Medicine, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
¹⁹ Department of Emergency Medicine, Liverpool Hospital, Sydney, New South Wales, Australia.
²⁰ Southwest Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.
²¹ Emergency Department, Luzerner Kantonsspital, Luzern, Switzerland.
²² Emergency Medicine, County Emergency Hospital Cluj-Napoca, University of Medicine and Pharmacy, Cluj-Napoca, Romania.
²³ Department of Public Health, Tours University Hospital, Tours, France.
²⁴ Department of Emergency Medicine, Santa Eugenio Hospital, Rome, Italy.
²⁵ Emergency Medicine, Chinese University of Hong Kong, Hong Kong.
²⁶ Servicio Urgencias Hospital Marqués de Valdecilla, Santander, Spain.
²⁷ School of Medicine, Tours University, Tours, France.
²⁸ Department of Medicine, Melbourne Medical School - Western Precinct, The University of Melbourne, Melbourne, Victoria, Australia.

PMID: 32748553
DOI: 10.1111/1742-6723.13567

Epidemiology, treatment and outcome of patients with lower respiratory tract infection presenting to emergency departments with dyspnoea (AANZDEM and EuroDEM studies)

Geoffroy Rousseau et al. Emerg Med Australas. 2021 Feb.

. 2021 Feb;33(1):58-66.

doi: 10.1111/1742-6723.13567. Epub 2020 Aug 3.

Authors

Affiliations

¹ Department of Emergency Medicine, Tours University Hospital, Tours, France.
² Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia.
³ School of Medicine, Bond University, Gold Coast, Queensland, Australia.
⁴ School of Medicine, Griffith University, Gold Coast, Queensland, Australia.
⁵ Emergency Department, Leiden University Medical Center, Leiden, The Netherlands.
⁶ Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia.
⁷ School of Clinical Sciences, Monash Health, Monash University, Melbourne, Victoria, Australia.
⁸ Department of Emergency Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey.
⁹ Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, Victoria, Australia.
¹⁰ Emergency Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
¹¹ Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK.
¹² Department of Emergency Medicine, National University Health System, Singapore.
¹³ Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
¹⁴ Emergency Medicine, University of Helsinki, Helsinki, Finland.
¹⁵ Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland.
¹⁶ Emergency Department, Auckland City Hospital, Auckland, New Zealand.
¹⁷ Department of Surgery, The University of Auckland, Auckland, New Zealand.
¹⁸ Department of Acute Medicine, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
¹⁹ Department of Emergency Medicine, Liverpool Hospital, Sydney, New South Wales, Australia.
²⁰ Southwest Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.
²¹ Emergency Department, Luzerner Kantonsspital, Luzern, Switzerland.
²² Emergency Medicine, County Emergency Hospital Cluj-Napoca, University of Medicine and Pharmacy, Cluj-Napoca, Romania.
²³ Department of Public Health, Tours University Hospital, Tours, France.
²⁴ Department of Emergency Medicine, Santa Eugenio Hospital, Rome, Italy.
²⁵ Emergency Medicine, Chinese University of Hong Kong, Hong Kong.
²⁶ Servicio Urgencias Hospital Marqués de Valdecilla, Santander, Spain.
²⁷ School of Medicine, Tours University, Tours, France.
²⁸ Department of Medicine, Melbourne Medical School - Western Precinct, The University of Melbourne, Melbourne, Victoria, Australia.

PMID: 32748553
DOI: 10.1111/1742-6723.13567

Abstract

Objective: Lower respiratory tract infection (LRTI) is a frequent cause of dyspnoea in EDs, and is associated with considerable morbidity and mortality. We described and compared the management of this disease in Europe and Oceania/South-East Asia (SEA) cohorts.

Methods: We conducted a prospective cohort study with three time points in Europe and Oceania/SEA. We included in this manuscript patients presenting to EDs with dyspnoea and a diagnosis of LRTI in ED. We collected comorbidities, chronic medication, clinical signs at arrival, laboratory parameters, ED management and patient outcomes.

Results: A total of 1389 patients were included, 773 in Europe and 616 in SEA. The European cohort had more comorbidities including chronic heart failure, obesity, chronic obstructive pulmonary disease and smoking. Levels of inflammatory markers were higher in Europe. There were more patients with inflammatory markers in Europe and more hypercapnia in Oceania/SEA. The use of antibiotics was higher in SEA (72.2% vs 61.8%, P < 0.001) whereas intravenous diuretics, non-invasive and invasive ventilation were higher in Europe. Intensive care unit admission rate was 9.9% in Europe cohort and 3.4% in Oceania/SEA cohort. ED mortality was 1% and overall in-hospital mortality was 8.7% with no differences between regions.

Conclusions: More patients with LRTI in Europe presented with cardio-respiratory comorbidities, they received more adjunct therapies and had a higher intensive care unit admission rate than patients from Oceania/SEA, although mortality was similar between the two cohorts.

Keywords: dyspnoea; emergency; epidemiology; lung disease.

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References

1. Kelly AM, Keijzers G, Klim S et al. An observational study of dyspnea in emergency departments: the Asia, Australia, and New Zealand Dyspnea in Emergency Departments Study (AANZDEM). Acad. Emerg. Med. 2017; 24: 328-36.
1. Niederman MS, Mandell LA, Anzueto A et al. Guidelines for the management of adults with community-acquired pneumonia: diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am. J. Respir. Crit. Care Med. 2001; 163: 1730-54.
1. Woodhead M, Blasi F, Ewig S et al. Guidelines for the management of adult lower respiratory tract infections. Clin. Microbiol. Infect. 2011; 17: E1-59.
1. Blasi F, Concia E, Del Prato B et al. The most appropriate therapeutic strategy for acute lower respiratory tract infections: a Delphi-based approach. J. Chemother. 2017; 29: 274-86.
1. Ieven M, Coenen S, Loens K et al. Aetiology of lower respiratory tract infection in adults in primary care: a prospective study in 11 European countries. Clin. Microbiol. Infect. 2018; 24: 1158-63.

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Epidemiology, treatment and outcome of patients with lower respiratory tract infection presenting to emergency departments with dyspnoea (AANZDEM and EuroDEM studies)

Affiliations

Epidemiology, treatment and outcome of patients with lower respiratory tract infection presenting to emergency departments with dyspnoea (AANZDEM and EuroDEM studies)

Authors

Affiliations

Abstract

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical