Patient-reported dyspnoea predicts six-fold increased hospital mortality

Patients can report respiratory discomfort (dyspnoea) on a 0-10 scale. Patients reporting dyspnoea at admission have a four-fold risk of in-hospital death. We asked whether assessing dyspnoea throughout hospitalisation identifies additional patients at risk of death or other poor outcomes.

We conducted a retrospective cohort study of non-intensive care unit patients at a tertiary care hospital. On each shift, bedside nurses documented patients' pain and dyspnoea ratings. We tested associations with inpatient mortality, 2-year mortality and other outcomes.

We evaluated 9785 admissions; 18% of patients reported dyspnoea at admission and 10% developed post-admission dyspnoea. Patients with post-admission-onset dyspnoea had six-fold greater odds of death during hospitalisation (OR 6.0, 95% CI 4.2-8.5, p<0.0001) versus patients without dyspnoea. Compared with those without dyspnoea, patients with dyspnoea had 50% greater mortality during the following 2 years, and those with dyspnoea on the day of discharge had even greater mortality (HR 2.6, 95% CI 2.1-3.2, p<0.0001). Higher patient dyspnoea ratings predicted higher in-hospital and 2-year mortality. Pain (reported by 72% of patients) was not significantly associated with mortality. Dyspnoea was also related to greater length of stay, rapid response team activation, transfer to the intensive care unit and discharge to extended care.

In contrast to pain, both admission dyspnoea and post-admission-onset dyspnoea were associated with substantially increased odds of poor patient outcomes during hospitalisation and following discharge. Documenting dyspnoea throughout hospitalisation provides a powerful alarm of clinical compromise that may warrant additional attention and outpatient follow-up.