Symptoms at presentation to the emergency department: Predicting outcomes and changing clinical practice?

Weigel, Karin; Nickel, Christian H.; Malinovska, Alexandra; Bingisser, Roland

doi:10.1111/ijcp.13033

Cited by 15 publications

(22 citation statements)

References 23 publications

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“…Additionally, these studies focused on single, main, presenting, or chief complaints. Therefore, it was never taken into account that most patients present with more than one symptom [3,7]. The model of chief complaint or main symptom heavily relies on several steps of selection and reduction of information.…”

Section: Discussionmentioning

confidence: 99%

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Combinations of Symptoms in Emergency Presentations: Prevalence and Outcome

Kuster

Nickel

Jenny

et al. 2019

JCM

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The predictive power of certain symptoms, such as dyspnoea, is well known. However, research is limited to the investigation of single chief complaints. This is in contrast to patients in the emergency department (ED) presenting usually more than one symptom. We aimed to identify the most common combinations of symptoms and to report their related outcomes: hospitalisation, admission to intensive care units, and mortality. This is a secondary analysis of a consecutive sample of all patients presenting to the ED of the University Hospital Basel over a total time course of 6 weeks. The presence of 35 predefined symptoms was systematically assessed upon presentation. A total of 3960 emergency patients (median age 51, 51.7% male) were included. Over 130 combinations of two, 80 combinations of three, and 10 combinations of four symptoms occurred 42 times or more during a total inclusion period of 42 days. Two combinations of two symptoms were predictive for in-hospital mortality: weakness and fatigue (Odds ratio (OR) = 2.45), and weakness and headache (OR = 3.01). Combinations of symptoms were frequent. Nonspecific complaints (NSCs), such as weakness and fatigue, are among the most frequently reported combinations of symptoms, and are associated with adverse outcomes. Systematically assessing symptoms may add valuable information for prognosis and may therefore influence triage, clinical work-up, and disposition.

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Section: Discussionmentioning

confidence: 99%

“…Previous studies were limited to the investigation of single symptoms. These did not take into account that patients reporting more than one symptom at presentation are the norm rather than the exception [3,7], and that combinations of certain symptoms might be able to predict adverse outcomes.…”

Section: Introductionmentioning

confidence: 99%

Combinations of Symptoms in Emergency Presentations: Prevalence and Outcome

Kuster

Nickel

Jenny

et al. 2019

JCM

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“…We have previously described that headache is among the most prevalent symptoms in ED patients, affecting more than one out of six patients, if patient-reported symptoms are not screened, or filtered by physicians [12]. As the majority of ED patients report more than one symptom [13], and headache patients report a median of four symptoms (often in combination with nonspecific complaints [14,15]), it is highly likely that previous studies have underreported headache, potentially due to inclusion bias and the physician filter. Constructs such as "chief complaint" or "main symptom" heavily rely on several steps of selection and reduction of information [16]-physicians tending to focus on frequent and specific presenting symptoms [17].…”

Section: Introductionmentioning

confidence: 99%

Nontraumatic Headache in Adult Emergency Patients: Prevalence, Etiologies, and Radiological Findings

Handschin

Oppliger

Psychogios

et al. 2020

JCM

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The aim of this study was to measure prevalence, to describe underlying etiologies, and to assess radiological findings, focusing on significant intracranial abnormality (sICA). This was a prospective study of unselected adult patients admitted to the emergency department (ED) in a tertiary care hospital where all presenters were systematically interviewed about their symptoms. We attributed nontraumatic headache with neuroimaging to four groups: Normal or no new finding, extracranial abnormality, insignificant intracranial abnormality, or significant intracranial abnormality. sICA was defined as “needing acute therapy”, “needing follow-up neuroimaging”, or “clinically important neurological disorder”. Among 11,269 screened ED presentations, the prevalence of nontraumatic headache was 10.1% (1132 patients). Neuroimaging (cCT and/or cMRI) was performed in 303 patients. Seventy (23.1% of scanned; 6.2% of all headache patients) patients had sICA. Etiologies were cerebrovascular disease (56%), intracranial bleeding (17%), tumors (14%), infection (9%), and others (6%). Short-term outcome was excellent, with 99.3% in-hospital survival in patients with and 99.4% in patients without neuroimaging, and 97.1% in sICA; 1-year survival in outpatients with neuroimaging was 99.2%, 99.0% in outpatients without, and 88.6% in patients with sICA. Factors associated with sICA were age, emergency severity index (ESI) of 1 or 2, Glasgow coma score (GCS) under 14, focal neurological signs, and a history of malignancy. Prevalence of headache and incidence of sICA were high, but survival after work-up for nontraumatic headache was excellent in the 94% patients without sICA. Due to the incidence of sICA, extensive indication for neuroimaging in headache patients is further warranted, particularly in patients with risk factors.

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“…However, over-reporting is conceivable, as more than one symptom could be chosen. In fact, the majority of our patients reported more than one symptom [38], the number of symptoms being unrelated to medically important outcomes. To our knowledge, no studies have reported age-stratified prevalence of underlying diseases in the last two decades.…”

Section: Discussionmentioning

confidence: 81%

“…First, this was a single-center study, and external validity is therefore limited. However, our ED cohort seems to represent the population of other urban, European EDs, with over two-thirds of patients having their origin in central or northern Europe [5] and the proportion of foreigners in our ED being about 32% [38]. An inclusion bias is possible, because almost 17% of patients could not be screened, and 6% were lost to follow-up.…”

Section: Discussionmentioning

confidence: 99%

Acute Abdominal Pain: Missed Diagnoses, Extra-Abdominal Conditions, and Outcomes

Osterwalder

Özkan

Malinovska

et al. 2020

JCM

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Abdominal pain (AP) is a common reason for presentation to an emergency department (ED). With this prospective, observational all-comer study, we aimed to answer three questions: Which diagnoses are most often missed? What is the incidence of extra-abdominal causes? What is the prognosis of abdominal pain in a tertiary urban European ED? Participants were systematically interviewed for the presence of 35 predefined symptoms. For all patients with abdominal pain, the index visit diagnoses were recorded. Related representation was defined as any representation, investigation, or surgery related to the index visit (open time frame). If a diagnosis changed between index visit and representation, it was classified as missed diagnosis. Among 3960 screened presentations, 480 (12.1%) were due to AP. Among 63 (13.1%) related representations, the most prevalent causes were cholelithiasis, gastroenteritis, and urinary retention. A missed diagnosis was attributed to 27 (5.6%) presentations. Extra-abdominal causes were identified in 162 (43%) presentations. Thirty-day mortality was comparable to that of all other ED patients (2.2% vs. 2.1%). Patients with abdominal pain had a low risk of representation, and the majority of representations due to missed diagnoses were of benign origin. The high incidence of extra-abdominal causes is noteworthy, as this may induce change to differential diagnosis of abdominal pain.

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Symptoms at presentation to the emergency department: Predicting outcomes and changing clinical practice?

Abstract: Background: The type and number of symptoms in emergency patients differ widely.

Cited by 15 publications

References 23 publications

Combinations of Symptoms in Emergency Presentations: Prevalence and Outcome

Combinations of Symptoms in Emergency Presentations: Prevalence and Outcome

Nontraumatic Headache in Adult Emergency Patients: Prevalence, Etiologies, and Radiological Findings

Acute Abdominal Pain: Missed Diagnoses, Extra-Abdominal Conditions, and Outcomes

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