Patient-reported dyspnoea predicts six-fold increased hospital mortality.

Background: 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. Methods: 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. Results: 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) Conclusions: 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.