A comparison of emergency department presentations for medically unexplained symptoms in frequent attenders during COVID-19

Daniels, Natasha Faye; Ridwan, Raiiq; Barnard, Ed; Amanullah, Talha Muneer; Hayhurst, Catherine

doi:10.7861/clinmed.2020-1093

Cited by 10 publications

(8 citation statements)

References 14 publications

(13 reference statements)

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“…This is particularly relevant given the emerging literature identifying an increase in FSS presentations to EDs after the commencement of the COVID-19 pandemic. 23 Our ndings suggest that frequent ED presenters with FSS contribute a disproportionately high number of service-episodes and are at an increased risk of re-presentation. We therefore suggest that individuals who frequently re-present to ED should be screened for FSS and referred to appropriate services.…”

Section: Discussionmentioning

confidence: 64%

“…These studies differ in their de nition of frequent presentations (> 2 visits in 2 years vs > 4 visits in six months) 7 18 and their criteria for somatization. A recent UK study found an increase in ED presentations for medically unexplained symptoms despite an overall reduction in presentations during the COVID-19 pandemic 19 . There is no known Australian published literature about the prevalence of FSS in frequent ED presenters and the current study seeks to address this gap.…”

Section: Introductionmentioning

confidence: 99%

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Functional Somatic Symptoms in Emergency Department Frequent Presenters

Garde

Thornton

Pardon

et al. 2023

Preprint

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Background: Patients with Functional Somatic Symptoms (FSS) are frequently encountered within healthcare settings such as Emergency Departments (ED). There is limited research regarding characterisation and frequency of FSS within frequent presenters to ED and no previous Australian evidence. This study aims to fill this gap. Methods: A retrospective, single-centre study of frequent ED presenters over a 6-month period was undertaken. Patients with >3 re-presentations/month were reviewed for the presence of FSS using Stephenson and Price’s 1 categorisation of FSS. Patients were divided into three groups – FSS, possible FSS (pos-FSS) and non-FSS. The characteristics of these groups were compared using descriptive statistics (chi-square tests, ANOVA). Person-time at risk during the 6-month study period was estimated for patients in each group and incidence of ED presentation for each group was then calculated. Psychological distress indicators for ED presenters with FSS, as noted by the treating clinician, were also analysed. Results: 11% (71/638) of frequent ED presenters were categorised as having FSS and 17% (109/638) as having possible FSS (pos-FSS). Mean ED presentations in the FSS group during the study period were significantly higher than in the non-FSS and pos-FSS groups (p<.01). Anxiety was found to be the primary psychological distress indicator associated with ED presentations with FSS. Conclusion: We found that, amongst frequent ED presenters, patients with FSS presented significantly more frequently to ED than those without FSS. We propose revising the model of care for FSS in ED to promote appropriate referral to therapy services as a possible demand reduction strategy to improve patient care and efficiency in ED.

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Section: Discussionmentioning

confidence: 64%

Section: Introductionmentioning

confidence: 99%

Functional Somatic Symptoms in Emergency Department Frequent Presenters

Garde

Thornton

Pardon

et al. 2023

Preprint

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“…It is interesting to note that these symptoms are comparable to the symptoms related to the COVID-19, which was excluded by a molecular nasopharyngeal swab for SARS-CoV-2 in our patients. Similarly, one of the rare, published studies analyzing SSD during the pandemic, conducted on the general population, reported that dyspnea-a well-known symptom of COVID 19 in adults-has increased in a statistically significant way [32]. Recent studies have attributed these symptoms to a possible long-COVID syndrome, defined as the symptoms that continue or develop after acute COVID-19 infection and which cannot be explained by an alternative diagnosis [25].…”

Section: Discussionmentioning

confidence: 99%

Clinical and psychopathological profiles of children with somatic symptom disorders in a pediatric emergency unit: an observational study before and during the SARS-CoV-2 pandemic

et al. 2023

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Somatic symptom disorders (SSDs) are a group of clinical conditions characterized by heterogeneous physical symptoms, not directly supported by a demonstrable organic process. Despite representing a growing problem in the pediatric age, the literature lacks studies assessing the psychopathological and clinical features of subjects with SSD, particularly during the SARS-CoV-2 pandemic. This is a retrospective, observational study, involving two historical cohorts of children admitted to a tertiary referral Italian hospital over the 2 years preceding and following the start of the SARS-CoV-2 pandemic. Demographic, clinical, socio-economical, and psychological variables were investigated. Standardized tests for the developmental age were administered to assess psychopathological variables. Overall rates and trends of accesses for SSD, as compared to the total accesses for any cause at the Pediatric Emergency Room during the same periods, were reported as well. Fifty-one (pre-pandemic, 29; pandemic, 22) children with SSD were enrolled (age, 11.4 ± 2.4 years, F = 66.7%). Subjects in the pandemic historical cohort reported more frequently fever ( p < 0.001), headache ( p = 0.032), and asthenia ( p < 0.001), as well as more chronic conditions in personal and family history, and fewer previous hospital accesses, as compared to the pre-pandemic cohort. Depressed mood and anxious traits were documented in both samples. None of them had an ongoing or a previously reported SARS-CoV-2 infection. During the pandemic, a clinical psychologist was more frequently consulted before the hospital discharge to mental health services, to support the diagnosis. Conclusion : This study showed the significant burden of SSD in children, highlighting the need to implement pediatricians’ education to optimize the management of these patients. Children with SSD who accessed during the SARS-CoV-2 pandemic presented specific clinical features. Future studies, conducted on longitudinal and controlled samples, are indicated to further investigate children with these conditions. What is Known: • Somatic symptoms disorders (SSDs) are frequent in the pediatric age, especially in early adolescence . • Evidence remains scarce on the impact of the SARS-CoV-2 pandemic on SSDs in children . What is New: • Children with SSD who accessed during the SARS-CoV-2 pandemic presented specific clinical features . • The implementation of pediatricians’ education and a multidisciplinary approach are needed to optimize the management of SSDs . Supplementary Information The online version contains supplementary material availa...

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“…Also, there was an increase of frequent attenders with Somatic Stress Disorder (SSD) by up to 79% during the pandemic compared to 1 year prior. 5 , 36 In EDs both false-positive COVID-19 hospital admissions and false-negative SSD misses can take place. 40 , 41 Psychosomatic symptoms in primary care are rampant (49% over 12-months) and their cost is similar to anxiety and depression disorders, 42 causing significant personal and systemic morbidity.…”

Section: Discussionmentioning

confidence: 99%

Somatic symptoms associated with mental distress during the COVID-19 pandemic: a systematic review

Theocharis

Antonopoulos

Christodoulou

2023

Australas Psychiatry

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Objective The primary objective of this article was to systematically review the prevalence of somatic symptoms in patients, healthcare workers and general population during the COVID-19 pandemic. The secondary objectives were to record the association between somatic symptoms and indices of mental distress and to record the qualitative characteristics of such somatic complaints. Methods Following the PRISMA methodology we systematically searched PubMed, Scopus and Google Scholar for primary research reporting on somatic symptoms in association with mental distress. We specifically sought papers reporting on bodily distress disorder, somatic symptoms disorder or medically unexplained symptoms. Results 1569 papers were retrieved, which yielded 36 relevant studies after screening. 15 studies referred to healthcare workers, 13 to general population, 5 to COVID-19 patients, 2 compared medical with non-medical professionals and 1 was studying COVID-19 patients some of which were also healthcare workers. The reported prevalence of somatic symptoms ranged from 7.4% to 67.8%. Commonly seen symptoms were shortness of breath, dyspnea, palpitations and pain in arms, legs and joints. Conclusions Our systematic review suggests that somatic symptoms are very frequent during the pandemic and are often linked to mental distress. All three population groups are affected.

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A comparison of emergency department presentations for medically unexplained symptoms in frequent attenders during COVID-19

Cited by 10 publications

References 14 publications

Functional Somatic Symptoms in Emergency Department Frequent Presenters

Functional Somatic Symptoms in Emergency Department Frequent Presenters

Clinical and psychopathological profiles of children with somatic symptom disorders in a pediatric emergency unit: an observational study before and during the SARS-CoV-2 pandemic

Somatic symptoms associated with mental distress during the COVID-19 pandemic: a systematic review

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