A dangerously underrated entity? Non-specific complaints at emergency department presentation are associated with utilisation of less diagnostic resources

Abstract

Background Patients presenting with non-specific complaints (NSC), such as generalised weakness, or feeling unwell, constitute about 20% of emergency care consultations. In contrast to patients presenting with specific symptoms, these patients experience more hospitalisations, longer stays in hospital and even higher mortality. However, little is known about the actual resources spent on patients with NSC in the emergency department (ED). Methods We have conducted a retrospective analysis from January 1st, 2013 until December 31st, 2017 in a Swiss tertiary care ED to assess the impact of NSC on the utilisation of diagnostic resources in adult patients with highlyurgent or urgent medical complaints. Results We randomly selected 1500 medical consultations from our electronic health record database: The majority of patients (n = 1310, 87.3%) presented with a specific complaint; n = 190 (12.7%) with a NSC. Univariate analysis showed no significant difference in the utilisation of total diagnostic resources in the ED [specific complaints: 844 (577–1313) vs. NSC: 778 (551–1183) tax points, p = 0.092, median (interquartile range)]. A backward selection logistic regression model was adjusted for the identified covariates (age, diabetes, cerebrovascular and liver disease, malignancy, past myocardial infarction, antihypertensive, antithrombotic or antidiabetic medication, night or weekend admission and triage category). This identified a significant association of NSC with lower utilisation of ED diagnostic resources [geometric mean ratio (GMR) 0.91, 95% CI: 0.84–0.99, p = 0.042]. Conclusions Non-specific complaints (NSC) are a frequent reason for emergency medicine consultations and are associated with lower utilisation of diagnostic resources during ED diagnostic testing than with specific complaints.

An analysis of patients with a chief complaint of difficulty moving

“…The present study showed that a variety of diseases can cause difficulties in movement. As no clear diagnostic algorithm has yet been established for emergency patients transported for a chief complaint of difficulty moving 32) , the present findings suggest the importance of obtaining the patient's history, evaluating vital signs, conducting a physical examination, laboratory examinations including blood culture, and physiological and radiological studies, including computed tomography.…”

Emergency department utilization and presenting chief complaints by Veterans living with dementia

“…However, in the case of nonspecific complaints, since not all of them appear to be more frequent among those with dementia, this will likely require interim work on better definition and identification for chief complaint standardization. Current standards (including this study as exploratory work with a novel data set) largely use physician review to distinguish nonspecific from specific complaints 46,47 …”

Decision Fatigue in Emergency Medicine: An Exploration of Its Validity

“…Diverse presentations: Patients in the emergency department present with a diverse array of medical conditions, from minor or nonspecific complaints to life-threatening emergencies. This diversity demands a wide range of diagnostic and treatment decisions [ 13 , 14 ].…”