Abstract
BackgroundThe chief or presenting complaint is the reason for seeking health care, often in the patient’s own words. In limited resource settings, a diagnosis-based approach to quantifying burden of disease is not possible, partly due to limited availability of an established lexicon or coding system. Our group worked with colleagues from the African Federation of Emergency Medicine building on the existing literature to create a pilot symptom list representing an attempt to standardize undifferentiated chief complaints in emergency and acute care settings. An ideal list for any setting is one that strikes a balance between ease of use and length, while covering the vast majority of diseases with enough detail to permit epidemiologic surveillance and make informed decisions about resource needs.MethodsThis study was incorporated as a part of a larger prospective observational study on human immunodeficiency virus testing in Emergency Departments in South Africa. The pilot symptom list was used for chief complaint coding in three Emergency Departments. Data was collected on 3357 patients using paper case report forms. Chief complaint terms were reviewed by two study team members to determine the frequency of concordance between the coded chief complaint term and the selected symptom(s) from the pilot symptom list.ResultsOverall, 3537 patients’ chief complaints were reviewed, of which 640 were identified as ‘potential mismatches.’ When considering the 191 confirmed mismatches (29.8%), the Delphi process identified 6 (3.1%) false mismatches and 185 (96.9%) true mismatches. Significant chief-complaint clustering was identified with 9 sets of complaints frequently selected together for the same patient. “Pain” was used 2076 times for 58.7% of all patients. A combination of user feedback and expert-panel modified Delphi analysis of mismatched complaints and clustered complaints resulted in several substantial changes to the pilot symptom list.ConclusionsThis study presented a systematic methodology for calibrating a chief complaint list for the local context. Our revised list removed/reworded symptoms that frequently clustered together or were misinterpreted by health professionals. Recommendations for additions, modifications, and/or deletions from the pilot chief complaint list we believe will improve the functionality of the list in low resource environments.
Highlights
The chief or presenting complaint is the reason for seeking health care, often in the patient’s own words
Our group worked with colleagues from the African Federation of Emergency Medicine building on work completed by Rice et al [3] to create a pilot symptom list for use in low resource settings, representing an attempt by an international criterion-setting body in emergency care to standardize this type of collection of undifferentiated chief complaints in the emergency and acute care setting
End-user feedback Functionality was approached through staff surveys and interviews with the human immunodeficiency virus (HIV) counsellors and nurses who completed the Case report form (CRF)
Summary
The chief or presenting complaint is the reason for seeking health care, often in the patient’s own words. The chief complaint can further be stratified based on acuity and those complaints designated as ‘high acuity’ have been found to independently predict mortality; enhanced attention and increased resources being made available to those with high risk chief complaints can improve patient health outcomes, and is the standard of care in many resource-rich settings [3]. This inherent value of the chief complaint has led to the development of ontologies of emergency care presenting complaints of varying degrees of sophistication; these have been predominantly derived in wealthy settings and not validated through most of the world [4–6]. An ideal list for any setting is one that strikes a balance between ease of use and length, while covering the vast majority of diseases with enough detail to permit epidemiologic surveillance and make informed decisions about resource needs
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