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. 2020 Jan 28;28(1):6.
doi: 10.1186/s13049-020-0699-y.

Nonspecific complaints in the emergency department - a systematic review

Kirsi Kemp  1 , Reija Mertanen  2 , Mitja Lääperi  2 , Leila Niemi-Murola  3 , Lasse Lehtonen  4 , Maaret Castren  2
Affiliations

Nonspecific complaints in the emergency department - a systematic review

Kirsi Kemp et al. Scand J Trauma Resusc Emerg Med. .

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.

Keywords: Adult; Emergency department; Emergency services; Length of stay; Mortality; Nonspecific complaint.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Prisma flow diagram for database searches
Fig. 2
Fig. 2
In-hospital Mortality
Fig. 3
Fig. 3
Comparison of classification to urgent triage class for patients presenting with SC and NSC
Fig. 4
Fig. 4
Comparison of hospital admission rate for patients presenting with NSC and SC
See this image and copyright information in PMC

Comment in

References

    1. Bhalla MC, Wilber ST, Stiffler KA, Ondrejka JE, Gerson LW. Weakness and fatigue in older ED patients in the United States. Am J Emerg Med. 2014;32(11):1395–1398. doi: 10.1016/j.ajem.2014.08.027. - DOI - PubMed
    1. Wachelder Joyce J. H., Stassen Patricia M., Hubens Laura P. A. M., Brouns Steffie H. A., Lambooij Suze L. E., Dieleman Jeanne P., Haak Harm R. Elderly emergency patients presenting with non-specific complaints: Characteristics and outcomes. PLOS ONE. 2017;12(11):e0188954. doi: 10.1371/journal.pone.0188954. - DOI - PMC - PubMed
    1. Nemec M, Koller MT, Nickel CH, Maile S, Winterhalder C, Karrer C, et al. Patients presenting to the emergency department with non-specific complaints: the Basel non-specific complaints (BANC) study. Acad Emerg Med. 2010;17(3):284–292. doi: 10.1111/j.1553-2712.2009.00658.x. - DOI - PubMed
    1. Djärv T, Castrén M, Mårtenson L, Kurland L. Decreased general condition in the emergency department. Eur J Emerg Med. 2015;22(4):241–246. doi: 10.1097/MEJ.0000000000000164. - DOI - PubMed
    1. Nickel CH, Malinovska A, Bingisser R. Should weakness be subsumed to nonspecific complaints?-correspondence in response to Bhalla et al. Am J Emerg Med. 2015;33(5):722–723. doi: 10.1016/j.ajem.2015.02.019. - DOI - PubMed

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