Adult Emergency Visits for Chronic Cardiorespiratory Disease: Does Dyspnea Matter?

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Abstract
Dyspnea is among the most common reasons for emergency department (ED) visits, yet little is known about how it is associated with visit characteristics and disposition or about how such associations differ across diagnoses. To characterize ED visits for chronic cardiorespiratory diseases in which dyspnea is a prominent symptom. Visit demographics and relations among reasons for presenting, visit urgency, medications, and visit disposition were examined. Data for this cross-sectional descriptive-exploratory study came from the 1992 National Hospital Ambulatory Medical Care Survey. All adult ED visits in the dataset for asthma (n = 395), chronic obstructive pulmonary disease (COPD; n = 239), and congestive heart failure (CHF; n = 320), as well as for mixed and restrictive chronic lung diseases (n = 18 and n = 14, respectively), were analyzed. Dyspnea was the most common reason for ED visit across diagnoses, and was associated with an approximate twofold increase in likelihood of admission for patients with COPD (odds ratio [OR] = 1.9, p < .04), and, controlling for age, CHF (OR = 1.7, p = .035). Dyspnea, alone or controlling for age, did not significantly increase the likelihood of admission for asthma. However, across all diagnoses, dyspnea was associated with a two- to threefold increase in the likelihood of receiving intravenous (i.v.) fluids (p < or = .006), whereas receiving an i.v. markedly increased the likelihood of admission (OR = 10.0, p < .0001 for COPD; OR = 10.2, p < .0001 for asthma; and OR = 3.8; p < .0001 for CHF). Age independently predicted admission for asthma and CHF, but not COPD. The percentage of nonurgent visits resulting in admission was markedly higher for COPD (19%) and CHF (41%) than for asthma (4%) or adult visits in general (6%). Reports of dyspnea increased the likelihood of admission from the ED either directly or indirectly, depending on diagnosis. Judgments of nonurgency may be less dependable in ED visits for COPD and CHF than for asthma or adult visits generally.