Patients Presenting to the Emergency Department With Non‐specific Complaints: The Basel Non‐specific Complaints (BANC) Study

Abstract

Objectives: Patient management in emergency departments (EDs) is often based on management protocols developed for specific complaints like dyspnea, chest pain, or syncope. To the best of our knowledge, to date no protocols exist for patients with nonspecific complaints (NSCs) such as ''weakness,'' ''dizziness,'' or ''feeling unwell.'' The objectives of this study were to provide a framework for research and a description of patients with NSCs presenting to EDs.Methods: Nonspecific complaints were defined as the entity of complaints not part of the set of specific complaints for which evidence-based management protocols for emergency physicians (EPs) exist. ''Serious conditions'' were defined as potentially life-threatening or those requiring early intervention to prevent health status deterioration. During a 6-month period, all adult nontrauma patients with an Emergency Severity Index (ESI) of 2 or 3 were prospectively enrolled, and serious conditions were identified within a 30-day period.Results: The authors screened 18,261 patients for inclusion. A total of 218 of 1,611 (13.5%) nontrauma ESI 2 and 3 patients presented with NSCs. Median age was 82 years (interquartile range [IQR] = 72 to 87), and 24 of 218 (11%) were nursing home inhabitants. A median of 4 (IQR = 3 to 5) comorbidities were recorded, most often chronic hypertension, coronary artery disease, and dementia. During the 30-day follow-up period a serious condition was diagnosed in 128 of 218 patients (59%). The 30-day mortality rate was 6%.Conclusions: Patients with NSC presenting to the ED are at high risk of suffering from serious conditions. Sensitive risk stratification tools are needed to identify patients with potentially adverse health outcomes.ACADEMIC EMERGENCY MEDICINE 2010; 17:284-292 ª

Common Diagnoses and Outcomes in Elderly Patients Who Present to the Emergency Department with Non-Specific Complaints

“…Our selection of cases was based on a previously published definition of "NSC," which included "all complaints that were not part of a set of specific complaints or signs or where an initial working diagnosis cannot be definitively established." 6 We excluded presenting complaints of dizziness or Diagnoses and outcomes for elderly patients with non-specific complaints…”

“…5 These findings collectively indicate that the evaluation and management of older patients is complicated, at least in part, by the fact that these patients often suffer from multiple comorbidities, polypharmacy, cognitive disorders, and not infrequently a failure of the referring health care provider or facility to provide appropriate communication and documentation. 2,6,7 The evaluation of older patients is further complicated when they present with a nonspecific complaint (NSC). Up to 20% of patients over the age of 75 present with NSCs such as fatigue, general weakness, dizziness, and recent falls.…”

“…9,10 Another study reported that during a 30-day follow-up period of elderly patients presenting to the ED with an NSC, a serious condition, defined as "potentially lifethreatening or requiring early intervention to prevent serious health status deterioration," was diagnosed in 59% of patients, 6% of whom died within 30 days. 6 In a cross-sectional study of 633 patients with NSCs, 12.2% of patient presentations were associated with a drug-related problem, such as polypharmacy, or problematic drug classes such as diuretics, benzodiazepines, antidepressants, and anti-convulsants. 11 The objectives of our study were to determine the most common diagnoses and outcomes of elderly patients presenting with general weakness, fatigue, and unwellness to the ED of two Canadian tertiary care hospitals and to identify factors independently associated with hospital admission and in-hospital mortality.…”

The “syncope and dementia” study: a prospective, observational, multicenter study of elderly patients with dementia and episodes of “suspected” transient loss of consciousness

“…Syncope and falls represent one of the major causes of mortality and morbidity in the older population [4], and, in addition to injury and increasing dependency, quality-oflife studies consistently show that functional impairment in persons with recurrent syncope is similar to other chronic disease [13,14]. Syncope is also the most frequent cause of hospitalization in elderly subjects with dementia, but there are no studies investigating the cause of syncope.…”

“…Furthermore, elderly subjects with dementia are referred to emergency departments with atypical or non-specific symptoms thus complicating the diagnosis [4].…”