title: The "prudent layperson" definition of an emergency medical condition.
abstract: The study objectives, based on federal and state legislative language, were to objectively define symptoms and signs commonly agreed on by "prudent laypersons" as "emergency medical conditions." After comprehensive tabulation of symptom classifications from the International Classification of Diseases (ICD-9), we performed a survey of nonmedical laypersons. Data analysis included descriptive statistics, proportional calculations, and 95% confidence intervals. A minority of symptoms and signs (25/87, 29%) were considered emergency medical conditions by more than half of nonmedical survey respondents who were self-defined as prudent laypersons. The leading conditions deemed emergencies were loss of consciousness, seizure, no recognition of one side of the body, paralysis, shock, gangrene, coughing blood, trouble breathing, chest pain, and choking. Pain, except for renal colic or chest pain, was not considered an emergency. No symptoms or signs specifically related to gynecologic disorders were considered emergencies. Most symptoms and signs tabulated in the diagnostic coding manual, ICD-9, are not considered emergency medical conditions by self-designated prudent laypersons. These include many conditions that are commonly investigated and treated in the emergency department setting. Use of the prudent layperson standard for reimbursable emergency health services may not reflect the actual scope of symptoms necessitating emergency care.
authors.affiliation: Division of Emergency Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA 02238, USA. jamesli@hms.harvard.edu
authors.forename: James
authors.initials: J
authors.lastname: Li
authors.forename: Hannah K
authors.initials: HK
authors.lastname: Galvin
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Johnson
mesh_terms: D000328:Adult; D001900:Boston; D003657:Decision Making; D004630:Emergencies / Q000145:classification*; D004636:Emergency Service, Hospital / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007349:Insurance, Health, Reimbursement; D008297:Male; D008329:Managed Care Programs / Q000191:economics; D008875:Middle Aged; D009626:Terminology as Topic; D014481:United States