A prospective audit of referrals for breathlessness in patients hospitalised for other reasons

A Mukhopadhyay, TK Lim
Correspondence: Dr Lim Tow Keang, mdclimtk@nus.edu.sg

ABSTRACT
Introduction This prospective audit examines the diagnostic and clinical outcomes of consecutive adult inpatients who were admitted to a university hospital for other reasons and referred for breathlessness to respiratory physicians.
Methods We enrolled all adult inpatients referred for breathlessness from May 2000 to October 2001. We evaluated the clinical features and utility of routine investigations, such as blood tests and radiology. Subsequent investigations were undertaken at the discretion of the physician.
Results Of the 105 patients, 49 were men and 56 were women. Their mean age was 66 plus or minus 18 years. Surgical departments and cardiology were the main referring departments. Respiratory infection (31 percent) was the most common diagnosis. Acute pulmonary embolism (PE) was diagnosed in four patients postoperatively. Chest radiographs were helpful in making a diagnosis in 66 percent of patients. Computed tomography pulmonary angiogram of the thorax was performed in 31 of the 34 patients who were investigated for acute PE. More postoperative than non-postoperative patients were tested for PE (p-value less than 0.0001).
Conclusion In hospitalised patients referred for breathlessness, respiratory infections were the most common diagnosis and the chest radiograph was the most useful initial investigation. Computed tomography pulmonary angiogram was the preferred investigation for acute PE and clinicians were more inclined to investigate for PE in postoperative patients.

Keywords: chest radiograph, computed tomography pulmonary angiogram, dyspnoea, pulmonary embolism
Singapore Med J 2005; 46(1): 21-24