Non-specific complaints at emergency department presentation result in unclear diagnoses and lengthened hospitalization: a prospective observational study - Sauter, T. C.; Capaldo, G.; Hoffmann, M.; Birrenbach, T.; Hautz, S. C.; Kammer, J. E.; Exadaktylos, A. K.; Hautz, W. E. (Scand J Trauma Resusc Emerg Med, 2018)
BACKGROUND: Up to 20% of patients admitted to an emergency department present with non-specific complaints. Retrospective studies suggest an increased risk of misdiagnosis and hospital admission for these patients, but prospective comparisons of the outcomes of emergency patients with non-specific complaints versus specific complaints are lacking. METHODS: All consecutive patients >/=18 years of age admitted to any internal medicine ward at Bern University Hospital via the emergency department from August 15th 2015 to December 7th 2015 were prospectively included and followed up upon. Patients with non-specific complaints were compared against those with specific complaints regarding the quality of their emergency department diagnosis, length of hospital stay and in-hospital mortality. RESULTS: Seven hundred and-eleven patients, 165 (23.21%) with non-specific complaints and 546 with specific complaints, were included in this study. No differences between patient groups regarding age, gender or initial severity of the medical problem (deducted from triage category and treatment in a resuscitation bay) were found. Patients with non-specific complaints received more unspecific diagnoses (30.3% vs. 23.1%, p = 0.001, OR = 1.82 [95% CI 1.159-2.899]), were hospitalized significantly longer (Median = 6.51 (IQR = 5.85) vs. 5.22 (5.83) days, p = 0.025, d = 0.2) but did not have a higher mortality than patients with specific complaints (7.3% vs. 3.7%, p = 0.087, OR 1.922 [95% CI 0.909-4.065]). CONCLUSIONS: Non-specific complaints in patients admitted to an emergency department result in low-quality diagnoses and lengthened hospitalization, despite the patients being comparable to patients with specific complaints at admission.
Keywords: journalArticle; *Diagnostic Errors; *Diagnostic Self Evaluation; *Guideline Adherence; 197/15) as a quality evaluation study. According to Swiss law, the need to obtain; Aged; Bangerter-Rhyner Foundation as well as research grants and lecture fees from; Bayer, Boehringer-Ingelheim, Daiichi-Sankyo and Bistol-Myers Squibb. WEH received; Critical Illness/epidemiology/*therapy; Emergency Service, Hospital/*standards; Emergency department; Female; Foundation Zuerich. GC, MH, TB, SCH, JEK, AKE report no conflict of interest; Hospital Mortality/trends; Humans; Incidence; Length of Stay/*trends; Length of stay; Male; Middle Aged; Non-specific complaints; PUBLISHER'S NOTE: Springer Nature remains neutral with regard to jurisdictional; Prospective Studies; Reproducibility of Results; Switzerland/epidemiology; Triage/*methods; applicable COMPETING INTERESTS: TCS received research grants from the; approved by the responsible ethics committee of the Canton Bern, Switzerland (Nr.; claims in published maps and institutional affiliations; informed consent was waived by the ethics committee. CONSENT FOR PUBLICATION: Not; research grants from Mundipharma Basel and paid educational consultancies from AO