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# Winter virus season impact on acute dyspnoea in the emergency department

Hanae Christiaens, Sandrine Charpentier, Charles-henri Houze-cerfon, Frédéric Balen

► To cite this version:

Hanae Christiaens, Sandrine Charpentier, Charles-henri Houze-cerfon, Frédéric Balen. Winter virus season impact on acute dyspnoea in the emergency department. The Clinical Respiratory Journal, 2019, 13 (11), pp.722-727. 10.1111/crj.13081. hal-04442030

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# Winter virus season impact on acute dyspnoea in the emergency department

Hanae Christiaens<fnref n="1" /> | Sandrine Charpentier<fnref n="1" />,<fnref n="2" />,<fnref n="3" /> | Charles-Henri Houze-Cerfon<fnref n="1" /> | Frederic Balen<fnref n="1" />,<fnref n="2" />,<fnref n="3" /> ID

### Correspondence

Frederic Balen, Emergency Department, Toulouse University Hospital, 31059 Toulouse, France.

Email: balen.f@chu-toulouse.fr

### Abstract

**Objective:** To compare the epidemiology of dyspnoea presented to emergency departments (EDs) during and of winter virus season (WVS).

**Methods:** This is a monocentric retrospective cohort study. All patients attending to the ED of the Rangueil University Hospital (Toulouse, France) for dyspnoea in September 2016 (off WVS period) and January 2017 (during WVS period) were included. The primary endpoint was the final diagnosis. The patients' medical profiles, care duration, seriousness and futures were studied as secondary endpoints.

**Results:** A total of 395 patients were studied: 125 patients during off-peak influenza season and 270 patients during the peak influenza season. The incidence of patients attending because of dyspnoea increased significantly during WVS (4.2% of ED presentations during the off WVS period versus 8.4% during the WVS period, *P* < 0.001). Patients attending the ED because of dyspnoea during WVS period were significantly older with more extensive medical backgrounds and more serious diseases. Most of those patients were hospitalized (54%), and largely in the geriatrics department.

**Conclusion:** The incidence of patients attending because of dyspnoea doubled during the WVS period, with patients who were older and had more complex histories. This time-consuming population largely requires hospitalization and may be one of the causes of the emergency department's overcrowding during epidemics.

### KEYWORDS

dyspnoea, emergency department, epidemiology, Upper respiratory infection

## 1 | INTRODUCTION

Upper respiratory infection and winter virus are frequently associated in the public representation of an increase of unjustified emergency department (ED) visits. Flu is the most known of this winter virus. Every year in Europe, the flu is responsible for an excess of mortality. According to Vestergaard et al,<fnref n="1" /> this daily excess may vary in between +25% and +50% at the peak of the epidemic. The upper respiratory infection, as flu, have dyspnoea as main symptom.<fnref n="2" /> Thus, in the field, we

noticed a recrudescence of dyspnoea during the winter virus season (WVS). Unfortunately, for emergency practitioners, dyspnoea and its epidemiological features are not well described for the ED population in the literature. Assessments and investigations are often based on the knowledge of the likely diseases. The hypothesis is that the number cases of dyspnoea and their seriousness is higher during WVS. This study can help us better understand dyspnoea in the ED and also brings data to adapt our hospitalization capacity during the epidemics.

<figure><img src="image_3.png" /></figure>

<footnote n="1">¹Emergency Department, Toulouse University Hospital, Toulouse, France</footnote>

<footnote n="2">²Laboratory of Epidemiology and Analyses in Public Health, UMR 1027 – EQUITY, INSERM, Toulouse, France</footnote>

<footnote n="3">³Toulouse III – Paul Sabatier University, Toulouse, France</footnote>
The primary objective of this study is to compare the epidemiology of dyspnoea presenting to EDs during and off WVS.

## 2 | MATERIALS AND METHODS

### 2.1 | Study design and settings

This retrospective, monocentric cohort study took place in the ED of Rangueil University Hospital in Toulouse (France). Rangueil's ED received 37 618 patients older than 15 years during 2017. According to epidemiological data, the flu season lasted from mid-December 2016 to mid-February 2017.³ Thus, the inclusion periods in this study were September 2016 for the “off WVS group” and January 2017 for the “during WVS group”.

This study was declared to the Research Department of our Hospital.

### 2.2 | Participants

All patients presenting to Rangueil's ED with dyspnoea from 1 to 30 September 2016 and from 2 to 31 January 2017 were included. Incomplete medical files were excluded.

### 2.3 | Data sources

All medical files containing the word “dyspnoea” as the chief complaint at initial nurse' triage were automatically collected. Then, those files were reviewed manually to extract demographic (age, sex, co-morbidity) and clinical (vital parameters) variables. Final diagnoses, quality indicators (initial triage by admission nurse, length of stay and mortality in ED), therapeutics (especially, ventilation support) and orientation were also collected. The primary endpoint was the number of patients attending the ED because of dyspnoea during the two periods. Final diagnosis, medical profile, length of stay, seriousness (evaluated by the FRENCHv2 initial triage score⁴ and mortality) and orientation were studied as secondary endpoints.

### 2.4 | Statistical methods

Statistical analysis of anonymized data was performed using the STATA13 software. No imputation method was used for missing values. The distribution of quantitative variables is represented by the mean followed by standard deviation. Qualitative data are expressed in number and percentage.

Comparative analyses were performed using the Student's *t* test for the comparison of quantitative variables. Regarding the comparison of qualitative variables, the chi-square test was used, where possible. Otherwise, Fischer's exact test

was performed. The threshold of statistical significance is considered to be reached if the risk of error is less than 5% (*P* < 0.05).

## 3 | RESULTS

### 3.1 | Patient's characteristics

The study flowchart is shown in Figure 1. A total of 395 patients were studied: 125 patients in the off WVS group and 270 patients in the during WVS group. The incidence of dyspnoea significantly increases during epidemics: patients with dyspnoea made up 4.2% (CI95: [3.5-5]) of the ED presentation off WVS versus 8.4% (CI95: [7.5-9.4]) during the WVS (*P* < 0.001). Patient characteristics are summarized in Table 1. Patients with dyspnoea during WVS were older: 76 ± 16 years old mean age versus 70 ± 19 years old off WVS. Sex ratios were respected in both populations (1 and 1.1). As regards their medical history, during WVS, patients with dyspnoea suffer significantly more often from kidney failure, stroke and peripheral arterial disease. In both groups, they had at least two pathologies in their medical history for approximately 80% of patients.

### 3.2 | Main diagnosis

Main diagnoses presented by patients during and off WVS are shown in Table 2. Off WVS, 24% of the main diagnoses were heart failure, 18% were respiratory tract infections, 18% were chronic bronchitis exacerbation, 13% were without a diagnosis, 10% were pleural effusion (almost half of them caused by cancer), 6% were inhalation pneumopathy and 6% were atrial fibrillation. Other diagnoses such as pneumothorax, asthma exacerbation, pulmonary fibrosis, myocardial infarction, pulmonary embolism, pericarditis, anaemia and anxiety attacks were less common (less than 5% each). During the

<figure><img src="image_4.png" /><figcaption>FIGURE 1 Flow chart</figcaption></figure>
<table><caption>TABLE 1 Baseline characteristics</caption><thead><tr><th rowspan="2">Patient characteristics</th><th colspan="2">Off winter virus season</th><th rowspan="2">During winter virus season</th><th rowspan="2">P</th></tr><tr><th>n = 125</th><th>n = 270</th></tr></thead><tbody><tr><td>Demographic</td><td></td><td></td><td></td><td></td></tr><tr><td>Age, mean ± SD</td><td>70 ± 19</td><td>76 ± 16</td><td></td><td>&lt;0.01</td></tr><tr><td>Women, n (%)</td><td>63 (50%)</td><td>131 (49%)</td><td></td><td>N.S</td></tr><tr><td>Co-morbidities</td><td></td><td></td><td></td><td></td></tr><tr><td>COPD</td><td>31 (25%)</td><td>68 (25%)</td><td></td><td>N.S</td></tr><tr><td>OSAS</td><td>10 (8%)</td><td>17 (6%)</td><td></td><td>N.S</td></tr><tr><td>Asthma</td><td>12 (10%)</td><td>24 (9%)</td><td></td><td>N.S</td></tr><tr><td>Pulmonary fibrosis</td><td>4 (3%)</td><td>19 (7%)</td><td></td><td>N.S</td></tr><tr><td>Ischaemic heart disease</td><td>44 (35%)</td><td>107 (40%)</td><td></td><td>N.S</td></tr><tr><td>Atrial fibrillation</td><td>30 (24%)</td><td>72 (27%)</td><td></td><td>N.S</td></tr><tr><td>Valvulopathy</td><td>8 (6%)</td><td>17 (6%)</td><td></td><td>N.S</td></tr><tr><td>Hypertension</td><td>52 (42%)</td><td>120 (44%)</td><td></td><td>N.S</td></tr><tr><td>Venous thromboembolism</td><td>12 (10%)</td><td>45 (17%)</td><td></td><td>N.S</td></tr><tr><td>Peripheral arterial disease</td><td>3 (2%)</td><td>20 (7%)</td><td></td><td>&lt;0.05</td></tr><tr><td>Diabetes</td><td>36 (29%)</td><td>66 (24%)</td><td></td><td>NS</td></tr><tr><td>Kidney failure</td><td>2 (2%)</td><td>24 (9%)</td><td></td><td>&lt;0.01</td></tr><tr><td>Cancer</td><td>29 (23%)</td><td>43 (16%)</td><td></td><td>N.S</td></tr><tr><td>Dementia/disability</td><td>9 (7%)</td><td>26 (10%)</td><td></td><td>N.S</td></tr><tr><td>Stroke</td><td>5 (4%)</td><td>31 (11%)</td><td></td><td>&lt;0.05</td></tr><tr><td>&gt;2 Co-morbidities</td><td>96 (77%)</td><td>217 (80%)</td><td></td><td>N.S</td></tr><tr><td>None</td><td>4 (3%)</td><td>11 (4%)</td><td></td><td>N.S</td></tr></tbody></table>

Note: Only probabilities with *P* < 0.05 are reported in this table.

Abbreviations: COPD, chronic obstructive pulmonary disease; OSAS, obstructive sleep apnoea syndrome.

epidemics, there is a significant increase in respiratory tract infections (+13%), heart failure (+11%) and kidney failure (+6%). Patients frequently have more than two diagnoses upon leaving the ED and this occurs even more often during WVS (+12%).

## 3.3 | Care duration, seriousness and orientation

The length of stay, seriousness and orientation of patients are shown in Table 3. Dyspnoea is a time-consuming symptom and even more so during epidemics: care duration is 3.3 times longer in this period (care duration in our study includes the duration of short emergency hospitalizations). During the WVS, patients presented with noticeably more serious conditions; patients presented more often with acute respiratory failure signs (+17%), oxygen had to be given more frequently (+17%) such as NIV (+16%). One endotracheal intubation and two deaths were reported in the during WVS group, with none reported in the off WVS group. Most of those patients were hospitalized, largely in the geriatrics department. Even if there was no significant difference concerning the percentages of hospitalizations,

we can notice that in absolute value, the number of patients hospitalized during the epidemics has more than doubled.

## 4 | DISCUSSION

This study depicts an updated view of the epidemiology of dyspnoea in the ER during and of WVS. As we can notice in our study, dyspnoea is quite common and even more so during epidemics: it represents 4.2% and 8.4% of ED admissions off and during WVS, respectively. Similar percentages are found in the literature. In Mockel et al's observational study, over a 1-year period, 7.4% of patients who visited the ED of Charité Berlin hospital presented with dyspnoea.⁵ In another observational study, Kelly et al found that patients with dyspnoea made up 5.2% of ED presentations in Asia, Australia and New Zealand.⁶

In France, elderly (patients older than 75 years old) represent only 12% of ED presentations.⁷ In our study, during WVS and off WVS, respectively, 48% and 58% of the patients included were more than 75 years old. Thus, dyspnoea mainly affects the elderly. This can be easily understood as this part of the population has more co-morbidities with a
<table><caption>TABLE 2 Diagnosis</caption><thead><tr><th rowspan="2">Diagnosis</th><th>Off-peak influenza season</th><th>Peak influenza season</th></tr><tr><th>n = 125</th><th>n = 270</th></tr></thead><tbody><tr><td>≥2 aetiologies</td><td>33 (26%)</td><td>103 (38%)</td></tr><tr><td>Respiratory causes</td><td>81 (65%)</td><td>194 (72%)</td></tr><tr><td>Flu</td><td>0 (0%)</td><td>12 (4%)</td></tr><tr><td>Bronchitis</td><td>2 (2%)</td><td>14 (5%)</td></tr><tr><td>Respiratory tract infection</td><td>23 (18%)</td><td>85 (31%)</td></tr><tr><td>Pleural effusion</td><td>13 (10%)</td><td>10 (4%)</td></tr><tr><td>Pneumothorax</td><td>2 (2%)</td><td>1 (0%)</td></tr><tr><td>Asthma exacerbation</td><td>3 (2%)</td><td>9 (3%)</td></tr><tr><td>Chronic bronchitis exacerbation</td><td>22 (18%)</td><td>44 (16%)</td></tr><tr><td>Pulmonary fibrosis</td><td>2 (2%)</td><td>5 (2%)</td></tr><tr><td>ENT disorders</td><td>1 (1%)</td><td>4 (1%)</td></tr><tr><td>Pleural effusion</td><td>13 (10%)</td><td>10 (4%)</td></tr><tr><td>Cardiologic causes</td><td>41 (33%)</td><td>118 (44%)</td></tr><tr><td>Atrial fibrillation</td><td>8 (6%)</td><td>16 (6%)</td></tr><tr><td>Myocardial infarction</td><td>1 (1%)</td><td>3 (1%)</td></tr><tr><td>Heart failure</td><td>30 (24%)</td><td>94 (35%)</td></tr><tr><td>Pulmonary embolism</td><td>1 (1%)</td><td>4 (1%)</td></tr><tr><td>Pericarditis</td><td>1 (1%)</td><td>1 (0%)</td></tr><tr><td>Other causes</td><td>22 (18%)</td><td>35 (13%)</td></tr><tr><td>Neoplasia</td><td>11 (9%)</td><td>7 (3%)</td></tr><tr><td>Anaemia</td><td>4 (3%)</td><td>6 (2%)</td></tr><tr><td>Kidney failure</td><td>0 (0%)</td><td>17 (6%)</td></tr><tr><td>Anxiety attack</td><td>4 (3%)</td><td>2 (1%)</td></tr><tr><td>Other</td><td>3 (2%)</td><td>3 (1%)</td></tr><tr><td>No aetiology found</td><td>16 (13%)</td><td>27 (10%)</td></tr></tbody></table>

Note: Data are reported as n (%).

Abbreviation: ENT = ear nose throat.

risk of deterioration. In 2040, approximately one in four inhabitants will be more than 65 years old (versus 18% in 2013)⁸; thus, dyspnoea is a growing problem. A serious revision of our means will soon be essential to adapt EDs to this specific population.

The most common co-morbidities in our study were cardiac and pulmonary pathologies. Hence, it is not surprising to find cardiac failure, chronic bronchitis exacerbation and respiratory tract infection ahead of dyspnoea's aetiology. Similar results were found in other studies.⁵,⁶,⁹,¹⁰

An increased number of patients are diagnosed with respiratory tract infections during the WVS (+13%). Indeed, the influenza virus can damage bronchial epithelium and thus it provides a beneficial environment for bacterial attachment.¹¹,¹²

The percentage of patients diagnosed with the flu is very low in our study (4%). It is not surprising, indeed, as flu with its flock of non-specific symptoms is hard to diagnose and flu diagnostic tests are not used in daily emergency management. A recent literature review shows that flu-resulting mortality is due not to a primary influenza illness but more accurately to co-morbidity exacerbation and secondary infections.²

Unknown aetiology represents 10%-13% of our patients. Dyspnoea is a subjective symptom and its aetiologies are polymorphic, thus it can be difficult to find a diagnosis. In Laribi et al's study, unknown diagnoses were classified with “other diagnoses” and account for 36%.¹⁰

Dyspnoea is a time-consuming symptom and even more so during epidemics. In a French epidemiology survey, only 23% of patients over 75 years old attending the ED stayed for more than 8 hours.¹³ In our study, care duration means for patients with dyspnoea were 10 hours and 43 minutes and 16 hours and 30 minutes, for the off WVS group and during WVS group, respectively. Therefore, our population's age is not the only explanation for extended care duration. Patients with dyspnoea require many investigative tests and are hospitalized for some time.⁶ Orientation delay and investigations both extend care duration and even more so during epidemics with hospital saturation. Dyspnoea symptoms are thus time consuming.

Mortality in our study is obviously lower than in Kelly et al and Mockel et al's studies (1% vs, respectively, 6%⁶ and 9.4%⁵). Similarly, our intensive care unit (ICU) admissions rate is lower than in Mockel and al. study. Those differences may be caused by the non-inclusion of patients coded as in “acute respiratory failure” by the admission nurse. Moreover, only the in-ED mortality were collected, and not the global in-hospital mortality. Seriousness is thus potentially underestimated in our study.

However, as this study is monocentric, its results cannot be generalized. Furthermore, as it is a retrospective study, there is an information bias.

## 5 | CONCLUSION

The incidence of patients attending the ED because of dyspnoea doubled during the WVS. They were older and had multiple pathologies responsible of their dyspnoea. These patients are often diagnosed with heart failure and respiratory tract infections. This time-consuming population largely requires hospitalization and may be one of the causes of the emergency department's overcrowding during epidemics. With an ageing population, dyspnoea is a growing problem. Such epidemiological data can be a first step to a better understanding of influenza season impact and its burden. Creating specific management algorithms for dyspnoea and opening special temporary units during winter
<table><caption>TABLE 3 Seriousness</caption><thead><tr><th></th><th></th><th>Off winter virus season<br>n = 125</th><th>During winter virus season<br>n = 270</th><th>P</th></tr></thead><tbody><tr><td rowspan="4">Care duration</td><td>Mean (h:min)</td><td>10:43</td><td>16:30</td><td rowspan="4">&lt;0.001</td></tr><tr><td>Maximum (h:min)</td><td>63:18</td><td>125:35</td></tr><tr><td>Minimum (h:min)</td><td>00:48</td><td>00:21</td></tr><tr><td>Total (h:min)</td><td>1340:05</td><td>4456:31</td></tr><tr><td rowspan="5">Seriousness</td><td>Triage score</td><td></td><td></td><td rowspan="5">&lt;0.001</td></tr><tr><td>1 = Resuscitation</td><td>1 (1%)</td><td>4 (1%)</td></tr><tr><td>2 = Emergency</td><td>10 (8%)</td><td>48 (18%)</td></tr><tr><td>3 = Urgent</td><td>68 (54%)</td><td>136 (50%)</td></tr><tr><td>4 = Less urgent</td><td>42 (34%)</td><td>66 (24%)</td></tr><tr><td>Vital parameters</td><td></td><td></td><td></td><td></td></tr><tr><td></td><td>Temperature &gt; 38°C</td><td>11 (9%)</td><td>42 (16%)</td><td>N.S</td></tr><tr><td></td><td>Systolic BP &lt; 90 mmHg</td><td>2 (2%)</td><td>8 (3%)</td><td>N.S</td></tr><tr><td></td><td>Heart rate &gt; 110 bpm</td><td>20 (16%)</td><td>46 (17%)</td><td>N.S</td></tr><tr><td></td><td>Respiratory rate &gt; 25/min</td><td>25 (20%)</td><td>60 (22%)</td><td>N.S</td></tr><tr><td></td><td>Acute respiratory failure signs</td><td>37 (30%)</td><td>127 (47%)</td><td>&lt;0.001</td></tr><tr><td>Ventilatory support</td><td></td><td></td><td></td><td></td></tr><tr><td></td><td>Oxygen</td><td>35 (28%)</td><td>121 (45%)</td><td>&lt;0.001</td></tr><tr><td></td><td>NIV</td><td>2 (2%)</td><td>23 (18%)</td><td>&lt;0.01</td></tr><tr><td></td><td>Endotracheal intubation</td><td>0</td><td>1 (1%)</td><td>N.S</td></tr><tr><td>Death in ED</td><td></td><td>0</td><td>2 (1%)</td><td>N.S</td></tr><tr><td>Hospitalization</td><td></td><td>61 (49%)</td><td>146 (54%)</td><td>N.S</td></tr></tbody></table>

Note: Data are reported as n (%). Only probabilities with P < 0.05 are reported in this table.

Abbreviation: NIV, non-invasive ventilation.

virus epidemics may be an answer to avoiding emergency saturation.

## CONFLICT OF INTEREST

The authors declare that they have no conflicts of interest with the contents of the article.

## AUTHOR CONTRIBUTIONS

Designed the work: Christiaens, Charpentier

Realised the acquisition and analysis of data: Christiaens, Charpentier

Interpretation: Christiaens, Charpentier

Performed complementary data analysis: Houze-Cerfon, Balen

Drafted the work: Houze-Cerfon, Balen

Revised it critically for important intellectual content: Houze-Cerfon, Balen

## ETHICS

As a retrospective cohort study, this study was only declared to the Research Department of our Hospital.

## ORCID

Frederic Balen https://orcid.org/0000-0002-4340-7391

## REFERENCES

1. Vestergaard LS, Nielsen J, Krause TG, et al. Excess all-cause and influenza-attributable mortality in Europe, December 2016 to February 2017. *Eurosurveillance*. 2017;22:1-7.

2. Gordon A, Reingold A. The burden of influenza: a complex problem. *Curr Epidemiol Rep*. 2018;5:1-9.

3. Occitanie C, Bourdillon F. Surveillance sanitaire en région Occitanie - Grippe: Bilan de l'épidémie hivernale 2016-2017. *Le point épidémiologique - INVS*. 2017. http://invs.santepubliquefr.ance.fr/content/download/147771/538013/version/274/file/pe_grippe_occitanie_bilan_2017_2018.pdf. Accessed June 1, 2019.

4. Taboulet P, Moreira V, Haas L, et al. Triage with the French emergency nurses classification in hospital scale: reliability and validity. *Eur J Emerg Med*. 2009;16(2):61-67.

5. Mockel M, Searle J, Muller R, et al. Chief complaints in medical emergencies: do they relate to underlying disease and outcome? *The Charité Emergency Medicine Study (CHARITEM). Eur J Emerg Med*. 2013;20:103-108.

6. Kelly AM, Keijzers G, Klim S, et al. An observational study of dyspnea in emergency departments: the Asia, Australia, and New Zealand dyspnea in emergency departments study. *Acad Emerg Med*. 2017;24:328-336.
7. Boisguérin B, Mauro L. Les personnes âgées aux urgences: une patientèle au profil particulier. Études et résultats - Ministère des Solidarités et de la Santé. DREES. 2017;No. 1007. https://drees.solidarites-sante.gouv.fr/IMG/pdf/er1007.pdf. Accessed June 1, 2019.

8. Blanpain N, Buisson G. Projections de population à l'horizon 2070. INSEE Première. 2016;No. 1619. https://www.insee.fr/en/statistiques/2581288. Accessed June 1, 2019.

9. Ray P, Birolleau S, Lefort Y, et al. Acute respiratory failure in the elderly: etiology, emergency diagnosis and prognosis. Crit Care. 2006;10:1-12.

10. Laribi S, Keijzers G, van Meer O, et al. Epidemiology of patients presenting with dyspnea to emergency departments in Europe and the Asia-Pacific region. Eur J Emerg Med. 2019;26:345-349.

11. Siemens N, Oehmcke-Hecht S, Mettenleiter TC, et al. Port d'Entrée for respiratory infections – does the influenza a virus pave the way for bacteria? Front Microbiol. 2017;8:1-17.

12. McCullers JA. Insights into the interaction between influenza virus and pneumococcus. Clin Microbiol Rev. 2006;19:571-582.

13. Boisguérin B, Mauro L. Les personnes âgées aux urgences: une santé plus fragile nécessitant une prise en charge plus longue. Études et résultats - Ministère des Solidarités et de la Santé. DREES. 2017;No. 1008. https://drees.solidarites-sante.gouv.fr/IMG/pdf/er1008.pdf. Accessed June 1, 2019.

**How to cite this article:** Christiaens H, Charpentier S, Houze-Cerfon C-H, Balen F. Winter virus season impact on acute dyspnoea in the emergency department. *Clin Respir J*. 2019;13:722-727. https://doi.org/10.1111/crj.13081