Disagreements between emergency patients and physicians regarding chief complaint - Patient factors and prognostic implications.

Abstract

The predictive power of chief complaints reported at presentation to the emergency department (ED) is well known. However, there is a lack of research on the coherence of patient versus physician reported chief complaints. The aim of this study was to determine the rate of disagreement between patients and physicians regarding chief complaint and its significance for the prediction of the outcomes number of resources used during ED work-up, hospitalisation, ICU admission, in-hospital mortality and hospital length of stay. In this secondary analysis of a study conducted over a time course of 9weeks, consecutive emergency patients and their physicians were independently asked to report the chief complaint upon presentation. The two reports were assessed for pair-wise agreement. Of 6722 emergency patients (mean age 53.3, 46.8% female), the median number of symptoms reported by patients was two and one reported by physicians. The rate of disagreement on chief complaints was 32.6%. Disagreement was associated with a higher number of resources (β=0.24; CI, 0.18, 0.31, P<.001) and hospitalisation (OR=1.31; CI, 1.16, 1.48, P<.001), using multivariable analyses. Patient factors associated with disagreement were age (OR=1.01; CI, 1.01, 1.01, P<.001), number of patient reported symptoms (OR=1.27; CI, 1.23, 1.32, P<.001) and male gender (OR=1.12; 1.01, 1.25, P=.0285). Disagreement on chief complaint between patient and physician may be an early marker for a complex work-up, requiring more resources and hospitalisations. The relevance of this finding is the newly identified signal of chief complaint replacement. It is easy to identify and should generate attention, as it affects a certain phenotype (older male patients with higher numbers of complaints).