Patients presenting to the emergency department with non-specific complaints: the Basel Non-specific Complaints (BANC) study.
OBJECTIVE
Patient management in emergency departments (EDs) is often based on management protocols developed for specific complaints like dyspnea, chest pain, or syncope. To the best of our knowledge, to date no protocols exist for patients with nonspecific complaints (NSCs) such as "weakness,""dizziness," or "feeling unwell." The objectives of this study were to provide a framework for research and a description of patients with NSCs presenting to EDs.


METHODS
Nonspecific complaints were defined as the entity of complaints not part of the set of specific complaints for which evidence-based management protocols for emergency physicians (EPs) exist. "Serious conditions" were defined as potentially life-threatening or those requiring early intervention to prevent health status deterioration. During a 6-month period, all adult nontrauma patients with an Emergency Severity Index (ESI) of 2 or 3 were prospectively enrolled, and serious conditions were identified within a 30-day period.


RESULTS
The authors screened 18,261 patients for inclusion. A total of 218 of 1,611 (13.5%) nontrauma ESI 2 and 3 patients presented with NSCs. Median age was 82 years (interquartile range [IQR]=72 to 87), and 24 of 218 (11%) were nursing home inhabitants. A median of 4 (IQR=3 to 5) comorbidities were recorded, most often chronic hypertension, coronary artery disease, and dementia. During the 30-day follow-up period a serious condition was diagnosed in 128 of 218 patients (59%). The 30-day mortality rate was 6%.


CONCLUSIONS
Patients with NSC presenting to the ED are at high risk of suffering from serious conditions. Sensitive risk stratification tools are needed to identify patients with potentially adverse health outcomes.
Nemec
Marek
M
Department of Emergency Medicine, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital, Basel, Switzerland.
Koller
Michael T
MT
Nickel
Christian H
CH
Maile
Silke
S
Winterhalder
Clemens
C
Karrer
Christine
C
Laifer
Gerd
G
Bingisser
Roland
R
D000058:Accidental Falls / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000704:Analysis of Variance; D002985:Clinical Protocols; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D004638:Emergency Treatment / Q000379:methods*; D005221:Fatigue / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006785:Hospitals, University; D006801:Humans; D016015:Logistic Models; D008297:Male; D018908:Muscle Weakness / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D013557:Switzerland / Q000453:epidemiology; D014218:Triage / Q000379:methods