Acute Dyspnea in the Emergency Medical Service in a Country with Limited Resources
-
Ango Privat Désiré
,
Mobio N'kan Michael Paterne
,
Kouamé Koffi Isidore
,
Coulibaly KT
,
Kouassi Konan Jean
,
Bédié Yao Vianney
,
Kouamé Antoine
Abstract
Background: The aim of this study was to identify the poor prognostic factors associated with acute dyspnea in medical emergencies.
Methods: A retrospective descriptive and analytical study conducted over a 12-month period (January 2022 to December 2022) in the medical emergency department of the Centre Hospitalier Universitaire de Treichville. All patients admitted to the medical emergency department for dyspnea during the study period were included.
Results: Prevalence was 7%. The mean age was 49 years, with a standard deviation of 16 years. The sex ratio was 1.08. Comorbidities were dominated by arterial hypertension (30.5%) and diabetes (14.7%). The majority of patients had NYHA stage 4 dyspnea (40%). Vital signs revealed arterial hypotension (45.5%), tachycardia (43.75%), tachypnea (66.9%), desaturation (52.2%), and disturbed consciousness (28.3%). The etiological diagnosis was dominated by bacterial pneumonia (35%), covid-19 pneumonia (22.4%), heart failure (21.7%), and pulmonary tuberculosis (13%). The mean time to therapeutic management was 3 hours and 23 minutes. Oxygen therapy was used in all patients. The average length of stay in the medical emergency department was 4 days ± 2 days. Mortality was 29% and was statistically associated with the existence of comorbidities (heart disease, arterial hypertension, tuberculosis, and diabetes), tachycardia (HR greater than 120 bpm), arterial hypotension (MAP less than 60 mmhg), tachypnea (respiratory rate greater than 30 cycles per minute), saturation less than 80%, and impaired consciousness (Glasgow score less than 14).
Conclusion: Dyspnea is responsible for a significant mortality rate. Several poor prognostic factors have been identified. Management of these factors could reduce mortality.
[2] Rosset-Zufferey S, Ramlawi M. Acute dyspnea in the emergency department: from pathophysiology to ultrasound. Rev Med Suisse. 2015; 11(482):1469-1473.
[3] Marguet C, Feray D, Bocquel N, Couderc L, Mallet E. Respiratory distress in pediatric emergency departments: Epidemiology and evaluation criteria. Arch Pédiatr. 2000; 7:4s-9s.
[4] Ibsen S, Lindskou TA, Nickel CH, Kløjgård T, Christensen EF, Søvsø MB. Which symptoms pose the highest risk in patients calling for an ambulance? Scand J Trauma Resusc Emerg Med. 2021; 29(1):59.
[5] Christiaens H, Charpentier S, Houze‐Cerfon CH, Balen F. Winter virus season impact on acute dyspnoea in the emergency department. Clin Respir J. 2019; 13(11):722-7.
[6] Moura P, Laurent N. A factor aggravating morbidity and mortality. Rev Med Suisse. 2015; 11(491):1955-1960.
[7] World Health Organization. Infection prevention and control of epidemic-and pandemic prone acute respiratory infections in health care. 2014. p. 156-156.
[8] Laribi S, Keijzers G, van Meer O, Klim S, Motiejunaite J, Kuan WS, et al. Epidemiology of patients presenting with dyspnea to emergency departments in Europe and the Asia-Pacific region. Eur J Emerg Med. 2019; 26(5):345-349.
[9] Ray P, Birolleau S, Lefort Y, Becquemin MH, Beigelman C, Isnard R, et al. Acute respiratory failure in the elderly: etiology, emergency diagnosis and prognosis. Crit Care. 2006; 10(3):R82.
[10] Codjo LH, Dohou SH, Agbodandé A, Karimou BM, Wanvoegbe AF, Attinsounon AC, et al. Evaluation de la qualité de la prise en charge de la dyspnée par les médecins généralistes à Parakou en 2013 [Evaluation of the quality of the management of dyspnea by GPs in Parakou in 2013]. Pan Afr Med J. 2015; 22:350.
[11] Gombet TH, Ellenga-Mbolla BF, Ikama MS, Okiemy G, Etitiele F. Urgences cardiovasculaires au centre hospitalier et universitaire de Brazzaville. Méd Afr Noire. 2007; 54(10):505-11.
[12] Achi HV, Bourhaima O, Djè-Bi H, Anon JC, Yeo L, N'Dhatz SM. Acute dyspnea in the emergency department of the Bouaké University Hospital (Ivory Coast). Rev Mal Respir. 2017; 34:A191.
[13] Garin N, Thorens JB, Berney JY, Meier F, Rutschmann O. La dyspnée de l'adulte [Dyspnea in adults]. Rev Med Suisse. 2012; 8(353):1732-3, 1735-8.
[14] Mockel M, Searle J, Muller R, Slagman A, Storchmann H, Oestereich P, et al. Chief complaints in medical emergencies: do they relate to underlying disease and outcome? Eur J Emerg Med. 2013; 20(2):103-8.
[15] Pfendler M, Ghuysen A, Vranckx M, Laribi S, Verschuren F. Epidémiologie des patients se présentant aux urgences pour dyspnée en Belgique [Epidemiology of patients presenting to the emergency room for dyspnea in Belgium]. Rev Med Liege. 2021; 76(4):273-279.
[16] Mobio N'Kan Michael Paterne, Bekoin Abhe CM, Ouattara Abdoulaye, Goulai Bi YEB, Bédié Yao Vianney, Tétchi YD. Maternal mortality in the emergency operating room of the CHU de Cocody-Abidjan-RCI. Rev Afr Anesth Med Urgence. 2018; 23(2):28-32.
[17] Tshabu-Aguèmon C, Denakpo J, Adisso S, Mampassi E, de Souza J. Maternal and Perinatal Mortality Related to Obstetrical Referrals to the C.U.G.O. of the CNHU-HKM in Cotonou. Rev Afr Anesth Med Urgence. 2012; 17:43-49.
[18] Mbutiwi Ikwa Ndol F, Dramaix-Wilmet M, Meert P, Lepira Bompeka F, Nseka Mangani N, Malengreau M, et al. Facteurs prédictifs de la mortalité des patients admis aux urgences médicales des cliniques universitaires de Kinshasa [Predictive factors of all-cause mortality in patients attending the medical emergency unit of Kinshasa University Hospital]. Rev Epidemiol Sante Publique. 2014; 62(1):15-25.
[19] Ouendo EM, Makoutodé M, Paraiso MN, Wilmet-Dramaix M, Dujardin B. Itineraire therapeutique des malades indigents au Benin (Pauvrete et soins de sante) [Therapeutic itinerary of poor patients in Benin (poverty and health care)]. Trop Med Int Health. 2005; 10(2):179-86.
[20] Januzzi JL, van Kimmenade R, Lainchbury J, Bayes-Genis A, Ordonez-Llanos J, Santalo-Bel M, et al. NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure. Eur Heart J. 2006; 27(3):330-7.
[21] KOMBILA UD, AYO EB, IGALA M, MOUNGUENGUI D, MBAYE FB, N’GOMANDA F, et al. Principales étiologies trouvées chez les patients admis en consultation spécialisée de pneumo-phtisiologie pour dyspnée chronique au Centre Hospitalier et Universitaire (CHU) de Libreville, Gabo. Rev Afr Méd Interne. 2020; 7(2-1):43-9.
[22] Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Pol Heart J (Kardiol Pol). 2016; 74(10):1037-147.
[23] Mbengono JA, Bengono RB, Nkodo JM, Essame TC, Amengle AL, Minkande JZ. Etiologies des décès dans les services d’urgences et de réanimation dans deux hôpitaux de la ville de Yaoundé. Health Sci Dis. 2015; 16(1).
[24] Méda ZC, Wend-Rabo DZ, Hien H, Ouattara CA, Ilboudo B, Traoré IT, et al. Facteurs influençant le délai de prise en charge aux urgences chirurgicales du CHU Sourô Sanou. Santé Publique. 2024; 36(2):109-18.
[25] Diango D, Coulibaly Y, Keïta M, et al. Delays in the management of surgical emergencies at Gabriel Touré Hospital in Bamako. JMARMU. 2007; 14(59):167-70.
[26] Bolandard F, Ballu, Constantin JM, Storme B, et al. Severe maternal morbidity in intensive care in the Auvergne region. Réanimation obstétricale. Ann Fr Anesth Réanim. 2006; 25 Suppl:158-161.
[27] Kouakou F, Effoh D, Loue V, et al. La pratique transfusionnelle en milieu gynéco obstétrique à Abidjan : A propos de 753 transfusions réalisées au CHU de Cocody. Rev Afr Anesth Med Urgence. 2011; 16(1):12- 21.
[28] Mbutiwi F, Meert P, Malengreau M, Nseka N, Dramaix-Wilmet M, Longo LA. Epidemiological profile of patients admitted to medical emergencies at the Cliniques Universitaires de Kinshasa (Democratic Republic of Congo). Ann Afr Méd. 2012; 5:1030-1043.
[29] Mobio N'kan Michael Paterne, Kouamé Koffi Isidore, Ango Privat Désiré, Koffi Bablé, Traore Sherif, Bédie Yao Vianney. Causes and characteristics of deaths in an emergency department in Abidjan (Ivory Coast). RISM. 2024; 26(3):205-212.
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