Perception of dyspnea in the elderly: Is it a reliable clinical sign?
Aslıhan Yürüktümen1, Özgür Karcıoğlu2, Hakan Topacoğlu3, Funda Karbek4
1Ege Üniversitesi Tıp Fakültesi Acil Tıp Anabilim Dalı, İzmir
2Acıbadem Hastanesi, Acil Servis, İzmir
3Dokuz Eylül Üniversitesi, Acil Tıp Anabilim Dalı, İzmir
4S.b. İzmir Atatürk Eğitim Ve Araştırma Hastanesi, Acil Tıp Kliniği, İzmir
Keywords: Perception, elderly; Borg scale; dyspnea severity
Abstract
Objective: There is insufficient data in the literature concerning the correlation between clinical and laboratory variables and the severity of dyspnea as perceived by the patient and the physician. The objective of this study is to investigate the correlation of dyspnea ratings with laboratory and clinical variables in elderly patients in the emergency department (ED).
Methods: The study involved all geriatric patients consecutively admitted in the ED with dyspnea uring th study period. Patients marked the severity of dyspnea using 100-mm VAS and Borg scales. Emergency physicians marked their estimates of dyspnea severity on Visual Analog Scale (VAS) and Medical Research Council Dyspne Scale (MRC). Correlation among the patients’ VAS, Borg and MRC scores and demografic patterns, clinical and laboratory findings was studied.
Results: Mean VAS score of the eligible patients (n=181) was 65.4 mm. VAS scores rated by the patients themselves was found to be significantly related to SaO2 (p=0.040), PaCO2 (p=0.010), pH (p=0.020) and respiratory rate (p=0.000) while unrelated to age, sex, level of education. Mean VAS score revealed by physicians was 50.5 mm and had significant relation with SaO2 (p=0.001), SpO2 (p=0.006), pH (p=0.000) and respiratory rate (p=0.006). MRC scores were found to be related to SaO2 (p=0.002), PaCO2 (p=0.017), pH (p=0.002), PaO2 (p=0.012), SpO2 (p=0.000), PEF (p=0.006) and respiratory rate (p=0.010) while Borg scores had significant relation with SaO2 (p=0.000), PaCO2 (p=0.014), PaO2 (p=0.000), PEF (p=0.045) and respiratory rate (p=0.000). VAS markings by patients was correlated with VAS rating by physicians (ρ=0.49, p=0.000), MRC (ρ=0.23, p=0.030), Borg scores (ρ=0.77, p=0.000). VAS rating by physicians was also correlated with MRC (ρ=0.41, p=0.000) and Borg scores (ρ=0.58, p=0.000). MRC scores with Borg scores (ρ=0.306, p=0.000) was significantly correlated.
Conclusions: VAS, Borg and MRC scales were used to indicate estimates of dyspnea severity of the patients in the ED correlates well with clinical and laboratory findings and could be viewed as a reliable guide in the management of elderly patients with dyspnea.