Incidence of pericardial effusion in patients presenting to the emergency department with unexplained dyspnea

Objective: To evaluate the frequency of pericardial effusion in patients pr esenting to the emergency department (ED) with unexplained, new-onset dyspn ea. Methods: This prospective observational study took place at an urban co mmunity hospital ED with a residency program and an annual census of 65,000 visits. Patients presenting between May 1999 and January 2000 with new-ons et dyspnea were eligible if they lacked any pulmonary, infectious, hematolo gical, traumatic, psychiatric, cardiovascular, or neuromuscular explanation for their dyspnea after ED evaluation. Patients received a focused echocar diogram by certified emergency physicians. Data were recorded on standardiz ed data sheets and studies were taped for review. Effusions were categorize d as small when the fluid stripe measured less than 10 mm. Moderate-sized e ffusions measured 10 to 15 mm. Large effusions measured more than 15 mm. Re sults: One hundred three patients were enrolled. Median age was 56 years (I QR 44, 95% CI = 32 to 67). Fourteen patients (13.6%, 95% CI = 8% to 23%) ha d effusions. Four had large effusions that explained their dyspnea and were admitted to cardiology; two of these effusions were hemorrhagic, and two w ere viral in origin. Seven patients with small effusions were treated conse rvatively at home. Three patients had moderate-sized effusions; all were ad mitted but treated conservatively. Conclusions: While limited by small numb ers, these preliminary data suggest that patients with unexplained dyspnea should be checked for pericardial effusion when bedside ED ultrasound is av ailable.