Nonspecific complaints in the emergency department – a systematic review

Abstract

Background Nonspecific complaint (NSC) is a common presenting complaint in the emergency setting, especially in the elderly population. Individual studies have shown that it is associated with significant morbidity and mortality. This prognostic systematic review draws a synthesis of reported outcomes for patients presenting with NSC and compares them with outcomes for patients presenting with a specific complaint. Methods We conducted a literature search for publications, abstracts and conference presentations from Ovid, Scopus and Web of Science for the past 20 years. Studies were included which treated adult patients presenting to the Emergency Medical Services or Emergency Department with NSC. 2599 studies were screened for eligibility and quality was assessed using the SIGN assessment for bias tool. We excluded any low-quality studies, resulting in nine studies for quantitative analysis. We analysed the included studies for in-hospital mortality, triage category, emergency department length of stay, admission rate, hospital length of stay, intensive care admissions and re-visitation rate and compared outcomes to patients presenting with specific complaints (SC), where data were available. We grouped discharge diagnoses by ICD-10 category. Results We found that patients presenting with NSC were mostly older adults. Mortality for patients with NSC was significantly increased compared to patients presenting with SC [OR 2.50 (95% CI 1.40–4.47)]. They were triaged as urgent less often than SC patients [OR 2.12 (95% CI 1.08–4.16)]. Emergency department length of stay was increased in two out of three studies. Hospital length of stay was increased by 1–3 days. Admission rates were high in most studies, 55 to 84%, and increased in comparison to patients with SC [OR 3.86 (95% CI 1.76–8.47)]. These patients seemed to require more resources than patients with SC. The number for intensive care admissions did not seem to be increased. Data were insufficient to make conclusions regarding re-visitation rates. Discharge diagnoses were spread throughout the ICD-10 main chapters, infections being the most prevalent. Conclusions Patients with NSC have a high risk of mortality and their care in the Emergency Department requires more time and resources than for patients with SC. We suggest that NSC should be considered a major emergency presentation.

Changing role of EMS –analyses of non-conveyed and conveyed patients in Finland

“…The most common code was weakness/tiredness, general (A04), seen in 13.5% of all patients. This is in concordance from recent finding from emergency departments [39]. Overall, it also seems that traditional high risk patient groups such as "first hour quintet" [40] represent a small minority of all patients encountered by the EMS.…”

Pre-hospital triage performance and emergency medical services nurse’s field assessment in an unselected patient population attended to by the emergency medical services: a prospective observational study

“…Patients with these diagnoses were commonly triaged to the RETTS-A category of non-specific complaints. Previous studies have shown that elderly patients with non-specific complaints in the ED have a higher short-term mortality, are to be triaged as less urgent and require resources and hospitalisation to a greater extent than patients with specific complaints [37,38]. There is also a risk of patients being referred to other levels of care with the aid of a triage system, with older patients being more frequently triaged to non-specific complaints than younger patients [39].…”

How should nonspecific complaints be defined? Comment to: “nonspecific complaints (NSCs) in the emergency department”

“…With great interest we have read the recent systematic review on "Nonspecific Complaints (NSCs) in the Emergency Department" [1] and would like to comment on two key aspects: First, we agree that NSCs should be considered a major emergency presentation. Different nomenclatures have been used in the past, such as "homecare impossible", "unexplained symptoms", "general disability", "atypical symptoms", and "nonspecific functional decline" (for review, see [2]).…”