Dyspnea duration, distress, and intensity in emergency department visits for heart failure.
Dyspnea duration, distress, and intensity in emergency department visits for heart failure.
复制标题
因心力衰竭急诊就诊时的呼吸困难持续时间、痛苦和强度。
DOI：
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发表时间：
2001
期刊：
影响因子：
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通讯作者：
Karma B. Cassidy
中科院分区：
文献类型：
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作者：
M. Parshall;J. Welsh;D. Brockopp;Regina M. Heiser;Mary P. Schooler;Karma B. Cassidy
背景
呼吸困难是到急诊科（艾德）就诊的心力衰竭（HF）患者中最常见的症状，但尚不清楚症状的哪些方面促使艾德就诊，或者呼吸困难特征是否与就诊分布相关。
目的
本研究的目的是探讨呼吸困难持续时间、痛苦和强度对HF患者决定到艾德就诊和就诊安排的影响。
方法
研究人群包括在城市大学医院艾德接受HF治疗的患者（N = 57），他们接受了回顾性访谈。开放式问题涉及访视时的一般症状和呼吸困难。受试者在决定前往艾德（决定）时和访视前一周（前一周）对回忆起的呼吸困难窘迫进行评级（0 =完全不受呼吸困扰; 4 =非常受呼吸困扰），以及持续时间-访视前回忆起的呼吸困难与决定时一样严重的天数。访谈结束后，一个子样本（n = 34）对一组呼吸困难感官质量描述符的强度进行评分（0 =不支持; 1 =非常轻微; 10 =非常严重）。还审查了图表。
结果
70%的人回忆说，呼吸困难是决定时最令人痛苦的症状，或者是就诊的主要原因; 88%的人入院。呼吸困难持续时间与入院无关。65%的样本持续时间为3天或更短，但35%为6天或更长。在呼吸困难痛苦或决策时的强度方面没有持续时间相关的差异，但持续时间≤ 3天的受试者报告的两个维度在前一周的水平较低，从前一周到决策时显著增加。那些发作时间较长的人在两个时间范围内都报告了高水平的痛苦和强度，两个维度都没有显着变化。
结论
受试者在决策时报告了高水平的痛苦和强度，无论呼吸困难持续时间如何。回忆持续时间的差异与2种不同的痛苦和强度评级模式相关，但与入院无关。呼吸困难持续时间似乎不是判断HF相关ED访视中病情严重程度的有效标准。
BACKGROUND
Dyspnea is the most common symptom among patients with heart failure (HF) who present to the emergency department (ED), but it is not clear which dimensions of the symptom prompt ED visits, or whether dyspnea characteristics are related to visit disposition.
PURPOSE
The goal of this study was to explore the influence of dyspnea duration, distress, and intensity on decisions of patients with HF to come to an ED and the disposition of visits.
METHODS
The study population consisted of patients treated for HF in an urban university hospital ED (N = 57) who were interviewed retrospectively. Open-ended questions pertained to symptoms in general and dyspnea at the time of the visit. Subjects rated recalled dyspnea distress (0 = not at all bothered by breathing; 4 = bothered very much by breathing) for when they decided to come to the ED (Decision) and a week before the visit (Week Before), as well as duration--the number of days before the visit that dyspnea was recalled as having been as severe as at Decision. After the interviews, a subsample (n = 34) rated the intensity of a set of dyspnea sensory quality descriptors for Decision and Week Before (0 = not endorsed; 1 = very mild; 10 = very severe). Charts were also reviewed.
RESULTS
Seventy percent recalled dyspnea as the most distressing symptom at Decision, or the primary reason for the visit; 88% were admitted. Dyspnea duration was unrelated to admission. Duration was 3 days or less for 65% of the sample, but 6 days or more for 35%. There was no duration-related difference in dyspnea distress or intensity at Decision, but subjects with a duration < or =3 days reported lower levels of both dimensions for Week Before with significant increases from Week Before to Decision. Those with longer episodes reported high levels of distress and intensity in both time frames with no significant change in either dimension.
CONCLUSION
Subjects reported high levels of distress and intensity at Decision, regardless of dyspnea duration. Differences in recalled duration were associated with 2 distinct patterns in distress and intensity ratings but were not associated with admission. Dyspnea duration does not appear to be a valid criterion for judging condition severity in HF-related visits to the ED.