Abstract
The predictive power of certain symptoms, such as dyspnoea, is well known. However, research is limited to the investigation of single chief complaints. This is in contrast to patients in the emergency department (ED) presenting usually more than one symptom. We aimed to identify the most common combinations of symptoms and to report their related outcomes: hospitalisation, admission to intensive care units, and mortality. This is a secondary analysis of a consecutive sample of all patients presenting to the ED of the University Hospital Basel over a total time course of 6 weeks. The presence of 35 predefined symptoms was systematically assessed upon presentation. A total of 3960 emergency patients (median age 51, 51.7% male) were included. Over 130 combinations of two, 80 combinations of three, and 10 combinations of four symptoms occurred 42 times or more during a total inclusion period of 42 days. Two combinations of two symptoms were predictive for in-hospital mortality: weakness and fatigue (Odds ratio (OR) = 2.45), and weakness and headache (OR = 3.01). Combinations of symptoms were frequent. Nonspecific complaints (NSCs), such as weakness and fatigue, are among the most frequently reported combinations of symptoms, and are associated with adverse outcomes. Systematically assessing symptoms may add valuable information for prognosis and may therefore influence triage, clinical work-up, and disposition.
Highlights
In the emergency department (ED), patients present with a wide range of symptoms and an even wider range of combinations of symptoms
Due to the finding that the majority of patients report multiple symptoms at presentation, we aimed to identify the most common combinations of symptoms and to assess their associated outcomes
5634 patients presented to the ED
Summary
In the emergency department (ED), patients present with a wide range of symptoms and an even wider range of combinations of symptoms. Assessing and interpreting these symptoms plays a crucial role in triage, routine workup, preliminary clinical diagnosis, as well as treatment and disposition [1]. Previous studies were limited to the investigation of single symptoms. These did not take into account that patients reporting more than one symptom at presentation are the norm rather than the exception [3,7], and that combinations of certain symptoms might be able to predict adverse outcomes
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