  avaliar a prevalncia de sintomas respiratrios como motivo para procura de atendimento de emergncia por pacientes adultos e peditricos , descrevendo as principais sndromes clnicas diagnosticadas e o desfecho dos pacientes .
entre novembro de 2008 e novembro de 2009 , o nmero total de atendimentos foi revisado diariamente .
durante o perodo do estudo , houve 37.059 admisses na emergncia , das quais 11.953 ( 32,3% ) foram motivadas por sintomas respiratrios . a prevalncia de atendimentos por sintomas respiratrios foi 28,7% e 38,9% nos adultos
e crianas , respectivamente . as taxas de internao hospitalar e de mortalidade nos adultos foram 21,2% e 2,7% , respectivamente , comparadas com 11,9% e 0,3% , respectivamente , nas crianas .
nos adultos , quanto maior o tempo entre o incio dos sintomas e a visita  emergncia , maiores foram a necessidade de hospitalizao ( p < 0,0001 ) , o tempo de hospitalizao ( p < 0,0001 ) e a mortalidade ( p = 0,028 ) .
  encontramos uma prevalncia elevada de atendimentos por sintomas respiratrios entre os pacientes adultos e peditricos .
futuros estudos epidemiolgicos podero colaborar para a melhor elucidao dos fatores de risco para a presena de sintomas respiratrios nesses pacientes . 

the prevalence of respiratory symptoms in a given population is an indirect indicator of acute and chronic respiratory diseases , an indicator that is quite reliable from an epidemiological standpoint . 




 
respiratory diseases are a leading cause of death among adults and children , accounting for 12% of all deaths worldwide . in low- and middle - income countries , upper respiratory tract infections ( urtis )
in addition to exerting enormous pressure on health services , respiratory diseases are common causes of school and work absenteeism . in brazil , chronic and acute respiratory diseases collectively rank second among the leading causes of hospitalization within the brazilian unified health care system , accounting for approximately 14% of all hospitalizations within the system . in southern
brazil , respiratory diseases are the leading cause of hospitalization ( accounting for 17% of all hospital admissions ) . 


 
respiratory complaints are the motive for a large proportion of outpatient visits , emergency room visits , and hospitalizations . 


 
a study conducted in a developing country 


  showed that 10% of all emergency room visits were due to respiratory diseases . in a two - year study conducted in the city of gama ,
brazil , 


  641,905 emergency room visits were evaluated , 37,642 ( 5.8% ) of which were found to be due to respiratory complaints .
studies on the pattern of emergency room visits by individuals with respiratory symptoms are important , because they could inform decisions regarding the organization and planning of health services in order to meet this demand . 




 
the objective of the present study was to evaluate the prevalence of respiratory symptoms as the motive for emergency room visits by adult and pediatric patients at a tertiary care hospital , describing the major clinical syndromes diagnosed and the patient outcomes .
this was a cross - sectional study conducted in the emergency room of the hospital de clnicas de porto alegre ( hcpa ) , located in the city of porto alegre , southern brazil .
the hcpa is a general tertiary care university hospital with 750 beds and approximately 30,000 admissions per year .
the city of porto alegre has 1,409,939 inhabitants , and the surrounding metropolitan area includes 31 cities , the total population of the greater metropolitan area being 3,979,561 .
the research ethics committee of the hcpa granted the researchers access to patient medical records .
children and adults who presented to the emergency room with at least one respiratory symptom were included in the study . during the study period ( between november of 2008 and november of 2009 )
, we reviewed the total number of visits per day to the pediatric and adult sections of the emergency room of the hcpa .
the electronic medical records were reviewed , and the characteristics of the patients treated for respiratory symptoms that were recorded included gender , age , race , smoking history , comorbidities , respiratory symptoms , and familial history of flu symptoms .
the respiratory symptoms considered were rhinorrhea , nasal congestion , odynophagia , dysphonia , cough , breathlessness , wheezing , chest pain , and fever .
clinical findings on admission ( axillary temperature , hr , rr , pulmonary auscultation findings , and spo2-measured by digital pulse oximetry ) were also recorded , as were the major clinical syndromes diagnosed and the patient outcomes ( icu admission , ward admission , discharge from the emergency room , and death ) .
data were entered into a microsoft excel 2007 database , after which they were processed and analyzed with the statistical package for the social sciences , version 18.0 ( spss inc . ,
we performed a descriptive analysis of the overall prevalence of visits by patients with respiratory symptoms to the pediatric and adult sectors of the emergency room ( for patients < 14 and  14 years of age , respectively ) .
we stratified the time from symptom onset to emergency room visit ( as < 7 days , 7 - 21 days , and > 21 days ) , as well as evaluating the major respiratory symptoms , the major clinical diagnoses , the length of the emergency room visit , the rate of admission to the hospital , the rate of icu admission , the rate of discharge from the emergency room , and the mortality rate .
during the 12-month study period , there were 37,059 emergency room visits ( 24,189 by adults and 12,870 by children ) , of which 11,953 ( 32.3% ) were motivated by respiratory symptoms .
the monthly variation in the number of emergency room visits due to respiratory symptoms is shown in figures 1 and 2 .
there was an increase in the number of such visits in april , may , and june .
the prevalence of visits due to respiratory symptoms was 28.7% ( 6,942/24,189 ) among adult patients and 38.9% ( 5,011/12,870 ) among pediatric patients .
the most common symptoms were cough ( in 73.4% ) , fever ( in 56.1% ) , breathlessness ( in 40.9% ) , chest pain ( in 24.5% ) , and rhinorrhea ( 20.9% ) .
the median duration of symptoms prior to admission was 3 days ( interquartile range : 1 - 6 days ) .
a total of 2,205 patients ( 18.5% ) admitted to the emergency room required hospitalization .
the demographic and clinical characteristics of the study population ( adults and children ) are shown in table 1 . 

figure 1monthly variation in the number of visits to the adult sector of the hospital de clnicas de porto alegre emergency room ( for patients  14 years of age ) motivated by respiratory symptoms , between november of 2008 and november of 2009 . 
 

figure 2monthly variation in the number of visits to the pediatric sector of the hospital de clnicas de porto alegre emergency room ( for patients < 14 years of age ) motivated by respiratory symptoms , between november of 2008 and november of 2009 . 
 

characteristicadultschildren(n = 6,942)(n = 5,011 ) 
 age , years 

 50.0 ( 30.0 - 55.0)2.0 ( 0.8 - 5.0 ) 
 male gender3,125 ( 45.0)2,795 ( 55.8 ) 
 white5,941 ( 85.6)4,007 ( 80.0 ) > 8 years of schooling3,129 ( 51.2)- 
 place of residence 

 porto alegre4,815 ( 69.4)3,635 ( 72.5 ) 

 greater metropolitan area of porto alegre1,851 ( 26.7)1,247 ( 24.9 ) 

 interior of the state of rio grande do sul276 ( 3.9)129 ( 2.6 ) 
 symptom upon arrival at the emergency room 

 cough4,553 ( 65.6)4,214 ( 84.1 ) 

 breathlessness3,521 ( 50.7)1,363 ( 27.2 ) 

 chest pain2,697 ( 38.9)229 ( 4.6 ) 

 rhinorrhea676 ( 9.7)1.821 ( 36.3 ) 

 nasal congestion263 ( 3.8)673 ( 13.4 ) 

 odynophagia897 ( 12.9)472 ( 9.4 ) 

 dysphonia102 ( 1.5)60 ( 1.2 ) 

 wheezing264 ( 3.8)760 ( 15.2 ) 

 fever2,986 ( 43.0)3,718 ( 74.2 ) 

 hemoptysis186 ( 2.7)4 ( 0.1 ) 
 duration of symptoms prior to arrival at the emergency room , days3.0 ( 1.0 - 7.0 ) 

 2.0 ( 1.0 - 4.0 ) 


 comorbidity 

 systemic arterial hypertension1,730 ( 24.9)0 

 asthma603 ( 8.7)777 ( 15.5 ) 

 copd730 ( 10.5)0 

 ischemic heart disease567 ( 8.2)0 

 heart failure554 ( 8.0)0 

 diabetes mellitus900 ( 13.0)6 ( 0.1 ) 

 hiv infection400 ( 5.8)32 ( 0.6 ) 

 cancer632 ( 9.1)48 ( 1.0 ) 

 chronic renal failure231 ( 3.3)0 
 smoking status 

 nonsmoker143 ( 2.1)0 

 former smoker712 ( 10.3)0 

 current smoker611 ( 8.8)0avalues expressed as n ( % ) , except where otherwise indicated .
bvalue expressed as mean  sdcvalues expressed as median ( interquartile range ) 
  values expressed as n ( % ) , except where otherwise indicated .  
value expressed as mean  sd values expressed as median ( interquartile range ) 
 table 2 shows the characteristics of the adult patients and the analysis of these characteristics on the basis of the time from symptom onset to emergency room visit . because data on the time from symptom onset to emergency room visit were not available for all patients , the analysis included only 4,434 patients .
of those 4,434 patients , 939 ( 21.2% ) were admitted to the hospital and 120 ( 2.7% ) died .
the median ( interquartile range ) length of emergency room visit and the median ( interquartile range ) total length of hospital stay were 0.5 day ( 0.5 - 1.0 day ) and 0.5 day ( 0.5 - 3.0 days ) , respectively .
the patients who had a 6-day or shorter history of respiratory symptoms ( < 7 group ) were younger than those who had a 7- to 21-day history ( 7 - 21 group ) and those who had a 21-day or longer history ( > 21 group ; 44.9  20.4 years vs. 49.4  19.7 years and 49.9  17.6 years ; p < 0.0001 ) . a longer time from symptom onset to emergency room visit correlated with a lower level of education of the patients ( p < 0.0001 ) .
when the proportion of patients who were residents of the city of porto alegre was higher , the time from symptom onset to emergency room visit was shorter ( p = 0.012 ) .
rhinorrhea , odynophagia , and fever were most common in the patients in the < 7 group , whereas cough and breathlessness were most common in those in the 7 - 21 group .
the number of patients with asthma was highest in the < 7 group ( p = 0.002 ) , and the number of patients with hiv infection was highest in the > 21 group ( p < 0.0001 ) . among the patients who underwent chest x - ray , normal results were more common in those in the < 7 group ( p < 0.0001 ) , and a consolidation pattern was more common in those in the 7 - 21 group ( p = 0.002 ) .
pleural effusion and diffuse infiltrates were most common in the > 21 group ( p = 0.008 and p = 0.003 , respectively ) .
the most common diagnoses in the < 7 group were influenza ( in 18.2% ) , pneumonia ( in 12.6% ) , and urti ( in 12.2% ) . in the 7 - 21 group ,
the most common diagnoses were pneumonia ( in 17.8% ) , urti ( in 10.7% ) , and copd exacerbation ( in 9.6% ) ; whereas the most common diagnoses in the > 21 group were pneumonia ( in 9.1% ) , copd exacerbation ( in 5.2% ) , and sinusitis ( in 4.3% ) .
the length of emergency room visit was shortest among the patients in the < 7 group ( p < 0.0001 ) .
a longer time from symptom onset to emergency room visit correlated with a greater need for hospitalization ( p < 0.0001 ) , longer hospital stays ( p < 0.0001 ) , and higher mortality ( p = 0.028 ) . 

table 2characteristics of the adult patients and analysis based on the time from onset of respiratory symptoms to emergency room visit . 


characteristictotaltime from symptom onset to emergency room visitp < 7 days7 - 21 days > 21 days(n = 4,434)(n = 3,024)(n = 1,179)(n = 230 ) 
 age , years 

 46.4  20.244.9  20.4 * 
 * * 
 49.4  19.7 * 
 49.9  17.6 * * 
 < 0.0001 
 male gender1,961 ( 44.2)1,355 ( 44.8)500 ( 42.4)106 ( 46.1)0.317 
 white3,791 ( 85.5)2,600 ( 86.0)598 ( 84.6)193 ( 83.9)0.438 > 8 years of schooling2,103 ( 53.5)1,506 ( 55.8 ) * 
 * * 
 498 ( 48.4 ) * 
 * * * 
 99 ( 48.1 ) * * 
 * * * 
 < 0.0001 
 place of residence 

 porto alegre3,110 ( 70.1)2,162 ( 71.5 ) * 
 * * 
 799 ( 67.8 ) * 
 * * 
 149 ( 64.8 ) * * 
 * * * 
 0.012 

 greater metropolitan area of porto alegre1,174 ( 26.5)777 ( 25.7)329 ( 27.9)68 ( 29.6)0.189 

 interior of the state of rio grande do sul150 ( 3.4)86 ( 2.8 ) * 
 * * 
 51 ( 4.3 ) * 
 * * 
 13 ( 5.7 ) * * 
 * * * 
 0.009 
 symptom upon arrival at the emergency room 

 cough3,132 ( 70.6)2,069 ( 68.4 ) * 
 * * 
 906 ( 76.8 ) * 
 * * * 
 157 ( 68.3 ) * * 
 * * * 
 < 0.0001 

 expectoration1,946 ( 28.0)795 ( 26.3 ) * 
 445 ( 37.7 ) * 
 * * * 
 60 ( 26.1 ) * * * 
 < 0.0001 

 breathlessness2,071 ( 46.7)1,335 ( 44,1 ) * 
 * * 
 621 ( 52.7 ) * 
 * * * 
 115 ( 50.0 ) * * 
 * * * 
 < 0 .. 001 

 chest pain1,841 ( 41.5)1,249 ( 41.3)495 ( 42.0)97 ( 42.2)0.900 

 rhinorrhea538 ( 12.1)422 ( 14.0 ) * 
 * * 
 102 ( 8.7 ) * 
 * * * 
 14 ( 6.1 ) * * 
 * * * 
 < 0.0001 

 nasal congestion203 ( 4.6)148 ( 4.9)49 ( 4.2)6 ( 2.6)0.201 

 odynophagia683 ( 15.4)547 ( 18.1 ) * 
 * * 
 124 ( 10.5 ) * 
 * * * 
 12 ( 5.2 ) * * 
 * * * 
 < 0.0001 

 dysphonia75 ( 1.7)49 ( 1.6)25 ( 2.1)1 ( 0.4)0.167 

 wheezing166 ( 3.7)113 ( 3.7)47 ( 4.0)6 ( 2.6)0.602 

 fever2,240 ( 50.5)1,645 ( 54.4 ) * 
 * * 
 518 ( 43.9 ) * 
 * * * 
 77 ( 33.5 ) * * 
 * * * 
 < 0.0001 

 hemoptysis118 ( 2.7)75 ( 2.5)35 ( 3.0)8 ( 3.5)0.494 
 comorbidity 

 systemic arterial hypertension1,071 ( 24.2)698 ( 23.1 ) * 
 * * 
 316 ( 26.8 ) * 
 * * * 
 57 ( 24.8 ) * * 
 * * * 
 0.039 

 asthma389 ( 8.8)291 ( 9.6 ) * 
 * * 
 90 ( 7.6 ) * 
 * * * 
 8 ( 3.5 ) * * 
 * * * 
 0.002 

 copd381 ( 8.6)249 ( 8.2 ) * 
 * * 
 122 ( 10.3 ) * 
 * * * 
 10 ( 4.3 ) * * 
 * * * 
 0.006 

 ischemic heart disease357 ( 8.1)261 ( 8.6)83 ( 7.0)13 ( 5.7)0.092 

 heart failure310 ( 7.0)212 ( 7.0)90 ( 7.6)8 ( 3.5)0.078 

 diabetes mellitus542 ( 12.2)376 ( 12.4)136 ( 11.5)30 ( 13.0)0.675 

 hiv infection278 ( 6.3)150 ( 5.0 ) * 
 * * 
 95 ( 8.1 ) * 
 * * * 
 33 ( 14.3 ) * * 
 * * * 
 < 0.0001 

 cancer302 ( 6.8)202 ( 6.7)88 ( 7.5)12 ( 5.2)0.407 

 chronic renal failure133 ( 3.0)95 ( 3.1)32 ( 2.7)6 ( 2.6)0.720 
 smoking status 

 nonsmoker107 ( 45.0)64 ( 43.5)32 ( 49.2)11 ( 42.3)0.714 

 former smoker452 ( 81.7)299 ( 88.5)124 ( 87.9)29 ( 76.3)0.112 

 current smoker405 ( 87.4)248 ( 81.0)128 ( 85.3)29 ( 72.5)0.160 
 radiological pattern 

 normal881 ( 38.7)593 ( 41.8 ) * 
 * * 
 241 ( 34.2 ) * 
 * * * 
 47 ( 30.9 ) * * 
 * * * 
 < 0.0001 

 consolidation498 ( 21.9)298 ( 21.0 ) * 
 * * 
 180 ( 25.5 ) * 
 * * * 
 20 ( 13.2 ) * * 
 * * * 
 0.002 

 diffuse infiltrate114 ( 5.0)57 ( 4.0 ) * 
 * * 
 42 ( 6.0 ) * 
 * * * 
 15 ( 9.9 ) * * 
 * * * 
 0.003 

 pleural effusion176 ( 7.7)91 ( 6.4 ) * 
 * * 
 68 ( 9.7 ) * 
 * * * 
 17 ( 11.2 ) * * 
 * * * 
 0.008 
 primary diagnosis 

 urti503 ( 11.3)368 ( 12.2 ) * 
 * * 
 126 ( 10.7 ) * 
 * * * 
 9 ( 3.9 ) * * 
 * * * 
 0.001 

 pneumonia612 ( 13.8)381 ( 12.6 ) * 
 * * 
 210 ( 17.8 ) * 
 * * * 
 21 ( 9.1 ) * * 
 * * * 
 < 0.0001 

 influenza614 ( 13.8)550 ( 18.2 ) * 
 * * 
 64 ( 5.4 ) * 
 * * * 
 0 ( 0 ) * * 
 * * * 
 < 0.0001 

 asthma204 ( 4.6)156 ( 5.2 ) * 
 * * 
 43 ( 3.6 ) * 
 5 ( 2.2)**0.022 

 copd331 ( 7.5)206 ( 6.8 ) * 
 * * 
 113 ( 9.6 ) * 
 * * * 
 12 ( 5.2 ) * * 
 * * * 
 0.004 

 sinusitis227 ( 5.1)134 ( 4.4 ) * 
 * * 
 83 ( 7.0 ) * 
 * * * 
 10 ( 4.3 ) * * 
 * * * 
 0.002 

 pulmonary tuberculosis42 ( 0.9)13 ( 0.4 ) * 
 * * 
 13 ( 1.1 ) * 
 16 ( 7.0 ) * * 
 < 0.0001 
 length of emergency room visit , days 

 0.5 ( 0.5 - 1)0.5 ( 0.5 - 1 ) * 
 * * 
 0.5 ( 0.5 - 2 ) * 
 0.5 ( 0.5 - 2 ) * * 
 < 0.0001 
 need for hospitalization939 ( 21.2)560 ( 18.5 ) * 
 * * 
 303 ( 25.7 ) * 
 * * * 
 76 ( 33.0 ) * * 
 * * * 

< 0.0001 
 need for icu admission119 ( 2.7)70 ( 2.3)39 ( 3.3)10 ( 4.3)0.056 
 length of hospital stay , days 

 0.5 ( 0.5 - 3.0)7 ( 3 - 14 ) * 
 * * 
 10 ( 6 - 19 ) * 
 * * * 
 14 ( 6 - 24 ) * * 
 * * * 
 < 0.0001 
 death120 ( 2.7)70 ( 2.3 ) * 
 * * 
 39 ( 3.3 ) * 
 * * * 
 11 ( 4.8 ) * * 
 * * * 
 0.028urti : upper respiratory tract infectionavalues expressed as n ( % ) , except where otherwise indicated.bvalue expressed as mean  sdcvalues expressed as median ( interquartile range).*comparison between the < 7 days and 7 - 21 days.**comparison between the < 7 days and > 21 days.***comparison between the 7 - 21 days and > 21 days . 
  :
upper respiratory tract infection values expressed as n ( % ) , except where otherwise indicated .
table 3 shows the characteristics of the pediatric patients and the analysis of those characteristics on the basis of the time from symptom onset to emergency room visit .
because , as was true for adults , data on the time from symptom onset to emergency room visit were not available for the entire group of pediatric patients , the analysis included only 3,860 patients .
of those 3,860 patients , 458 ( 11.9% ) were admitted to the hospital and 12 ( 0.3% ) died .
the median length of the emergency room visit and median length of hospital stay were equal : 0.5 days ( range , 0.5 - 0.5 days ) .
the pediatric patients in the > 21 group were younger than were those in the < 7 and 7 - 21 groups ( p = 0.023 ) .
fever and odynophagia were most common in the patients in the < 7 group ( p < 0.0001 and p = 0.008 , respectively ) .
in all three of those groups , the most common diagnoses were influenza ( p < 0.0001 ) , pneumonia ( p = 0.014 ) , and sinusitis ( p = 0.002 ) . among the pediatric patients , the type of symptom(s ) presented did not correlate significantly with the length of emergency room visit , length of hospital stay , or mortality . 

table 3characteristics of the pediatric patients and analysis based on the time from onset of respiratory symptoms to emergency room visit.characteristictotaltime from symptom onset to emergency room visitp < 7 days7 - 21 days > 21 days(n = 3,860)(n = 3,242)(n = 574)(n = 44 ) 
 age , years 

 2.0 ( 0.8 - 5.0)2.0 ( 0.8 - 5.0 ) * * 
 1.0 ( 0.7 - 5.0 ) * * * 
 0.9 ( 0.5 - 3.0 ) * * 
 * * * 
 0.023 
 male gender2,116 ( 54.8)1,771 ( 54.6)322 ( 56.1)23 ( 52.3)0.762 
 white3,085 ( 79.9)2,602 ( 80.3)447 ( 77.9)36 ( 81.8)0.401 
 place of residence 

 porto alegre2,806 ( 72.7)2,352 ( 72.5)420 ( 73.2)34 ( 77.3)0.754 

 greater metropolitan area of porto alegre963 ( 24.9)815 ( 25.1)138 ( 24.0)10 ( 22.7)0.806 

 interior of the state of rio grande do sul91 ( 2.4)75 ( 2.3)16 ( 2.8)0 ( 0)0.461 
 symptom upon arrival at the emergency room 

 cough3,311 ( 85.8)2,765 ( 85.3)507 ( 88.3)39 ( 88.6)0.136 

 breathlessness988 ( 25.6)837 ( 25.8)140 ( 24.4)11 ( 25.0)0.767 

 chest pain181 ( 4.7)151 ( 4.7)30 ( 5.2)0 ( 0)0.280 

 rhinorrhea1,459 ( 37.8)1,213 ( 37.4)233 ( 40.6)13 ( 29.5)0.184 

 nasal congestion544 ( 14.1)442 ( 13.6)95 ( 16.6)7 ( 15.9)0.170 

 odynophagia374 ( 9.7)334 ( 10.3 ) * 
 * * 
 39 ( 6.8 ) * 
 * * * 
 1 ( 2.3 ) * * 
 * * * 
 0.008 

 dysphonia47 ( 1.2)37 ( 1.1)9 ( 1.6)1 ( 2.3)0.563 

 wheezing575 ( 14.9)488 ( 15.1)77 ( 13.4)10 ( 22.7)0.203 

 fever2,985 ( 77,3)2,554 ( 78.8 ) * 
 * * 
 406 ( 70.7 ) * 
 * * * 
 25 ( 56.8 ) * * 
 * * * 
 < 0.0001 
 comorbidity 

 asthma587 ( 15.2)506 ( 15.6)74 ( 12.9)7 ( 15.9)0.246 

 hiv infection25 ( 0.6)21 ( 0.6)4 ( 0.7)0 ( 0)0.857 

 cancer35 ( 0.9)30 ( 0.9)5 ( 0.9)0 ( 0)0.809 

 history of bronchiolitis 117 ( 3.0)98 ( 3.0)18 ( 3.1)1 ( 2.3)0.947 
 radiological pattern 

 normal651 ( 47.7)539 ( 48.8)98 ( 43.8)14 ( 60.9)0.210 

 consolidation300 ( 22.0)232 ( 20.8 ) * 
 * * 
 64 ( 28.4 ) * 
 * * * 
 4 ( 17.4 ) * * 
 * * * 
 0.035 

 diffuse infiltrate137 ( 10.0)115 ( 10.3)19 ( 8.4)3 ( 13.0)0.623 
 primary diagnosis 

 urti980 ( 25.4)816 ( 25.2)155 ( 27.0)9 ( 20.5)0.487 

 pneumonia381 ( 9.9)301 ( 9.3 ) * 
 * * 
 76 ( 13.2 ) * 
 * * * 
 4 ( 9.1 ) * * 
 * * * 
 0.014 

 influenza356 ( 9.2)326 ( 10.1 ) * 
 * * 
 28 ( 4.9 ) * 
 * * * 
 2 ( 4.5 ) * * 
 * * * 
 < 0.0001 

 asthma486 ( 12.6)426 ( 13.1)56 ( 9.8)4 ( 9.1)0.062 

 bronchiolitis366 ( 9.5)303 ( 9.3)57 ( 9.9)6 ( 13.6)0.580 

 sinusitis63 ( 1.6)43 ( 1.3 ) * 
 * * 
 18 ( 3.1 ) * 
 * * * 
 2 ( 4.5 ) * * 
 * * * 
 0.002 
 length of emergency room visit , day 

 0.5 ( 0.5 - 0.5)0.5 ( 0.5 - 0.5)0.5 ( 0.5 - 0.5)0.5 ( 0.5 - 0.5)0.182 
 need for hospitalization458 ( 11.9)376 ( 11.6)73 ( 12.1)9 ( 20.5)0.156 
 need for icu admission27 ( 0.7)22 ( 0.7)5 ( 0.9)0 ( 0)0.751 
 length of hospital stay , days 

 0.5 ( 0.5 - 0.5)6 ( 3 - 11)5 ( 3 - 10)11 ( 4.5 - 20.5)0.179 
 mortality rate12 ( 0.3)9 ( 0.3)3 ( 0.5)0 ( 0)0.582urti : upper respiratory tract infection.avalues expressed as n ( % ) , except where otherwise indicated . bvalue expressed as mean  sd.cvalues expressed as median ( interquartile range).*comparison between the < 7 days and 7 - 21 days * * comparison between the < 7 days and > 21 days***comparison between the 7 - 21 days and > 21 days . 
  :
comparison between the < 7 days and 7 - 21 days   comparison between the < 7 days and > 21 days comparison between the 7 - 21 days and > 21 days .
in this cross - sectional study , we have described the characteristics of adult and pediatric patients presenting to the emergency room of a tertiary care hospital with respiratory symptoms . in one year , the prevalence of emergency room visits due to respiratory symptoms was 28.7% and 38.9% among adult and pediatric patients , respectively . in adults ,
the rates of hospitalization and mortality were 21.2% and 2.7% , respectively , compared with 11.9% and 0.3% , respectively , in children . in a study conducted at various emergency rooms in a city in italy , 


  only 5% of all visits by adults were motivated by respiratory symptoms .
the same percentage was found by another group of authors , 


  who also reported that 47% of patients presenting to primary care did so because of respiratory symptoms . at 77 basic health care facilities in algeria ,
the presence of respiratory symptoms was the motive for seeking medical attention in up to 31.6% of the cases . 


  in our sample ,
the number of patients who sought treatment because of respiratory symptoms might have been overestimated because of the influenza a ( h1n1 ) pandemic , which occurred during the study period .
this also explains the high prevalence of diagnoses of influenza and urti in patients treated at the emergency room of the tertiary care hospital .
likewise , upper respiratory tract symptoms , such as rhinorrhea and odynophagia , as well as fever , were more common in the adult patients presenting to the emergency room with a  6-day history of respiratory symptoms , perhaps out of concern regarding the possibility of having a ( h1n1 ) influenza .
the adult patients who had a  6-day history of respiratory symptoms were younger than were the other patients .
it is known that elderly patients with pneumonia have lower body temperature and that it can take them longer to seek medical attention , increasing the likelihood of delayed diagnosis and delayed treatment . 


 
in fact , the higher number of patients diagnosed with pneumonia in the 7 - 21 and > 21 groups corroborates this finding .
a higher level of education was found in the group of adult patients who presented to the emergency room earlier ( < 7 group ) .
studies have demonstrated that individuals with a higher level of education have a healthier behavior , have more information about their health , and clearly understand the instructions provided at discharge from the emergency room . 


 
in general , those with a higher level of education tend to make better health - related decisions .
therefore , considering the context of the influenza a ( h1n1 ) epidemic , it is possible that these patients sought medical attention earlier for fear of this pathology . in the adult patients
, we found that a longer time from symptom onset to emergency room visit correlated with a greater need for hospitalization , longer hospital stays , and higher mortality .
respiratory symptoms are associated with various diseases and are considered significant predictors of mortality . 


  among respiratory symptoms ,
in fact , in our study , we found that breathlessness was more common in the 7 - 21 and > 21 groups than in the < 7 group , probably indicating greater severity and chronicity of symptoms in the first two groups .
we included only patients presenting to the emergency room , and those probably represented cases that were more severe than those treated in primary care .
in addition , the diagnoses were syndromic ( i.e. , the etiologic agent was not identified ) .
however , despite these limitations , the study achieved its objective of showing the characteristics of patients with respiratory symptoms and is relevant for the evaluation of these patients in the context of emergency care . in conclusion
, we have described the epidemiological profile of adult and pediatric patients presenting to an emergency room with respiratory symptoms .
we found a high prevalence of respiratory symptoms as the motive for emergency room visits by adult and pediatric patients ( in 28.7% and 38.0% , respectively ) .
in addition , we found that a longer time from symptom onset to emergency room visit correlated with a greater need for hospitalization , longer hospital stays , and higher mortality among adults .
further longitudinal epidemiological studies are needed in order to clarify the risk factors for severe respiratory symptoms .
 objective : to evaluate the prevalence of respiratory symptoms as the motive for emergency room visits by adult and pediatric patients , describing the major clinical syndromes diagnosed and the outcomes of the patients . 
 methods : a cross - sectional study conducted in the emergency room of a tertiary care university hospital . between november of 2008 and november of 2009 , we reviewed the total number of emergency room visits per day . 
 children and adults who presented with at least one respiratory symptom were included in the study . 
 the electronic medical records were reviewed , and the major characteristics of the patients were recorded . 
 results : during the study period , there were 37,059 emergency room visits , of which 11,953 ( 32.3% ) were motivated by respiratory symptoms . 
 the prevalence of emergency room visits due to respiratory symptoms was 28.7% and 38.9% among adults and children , respectively . in adults , the rates of hospitalization and mortality were 21.2% and 2.7% , respectively , compared with 11.9% and 0.3% , respectively , in children . among the adults , 
 the time from symptom onset to emergency room visit correlated positively with the need for hospitalization ( p < 0.0001 ) , the length of the hospital stay ( p < 0.0001 ) , and the mortality rate ( p = 0.028 ) . 
 conclusions : we found a high prevalence of respiratory symptoms as the motive for emergency room visits by adult and pediatric patients . 
 our results could inform decisions regarding the planning of prevention measures . 
 further epidemiological studies are needed in order to clarify the risk factors for severe respiratory symptoms . 
 
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Introduction
Methods
Results
Discussion