title: Chief complaints in medical emergencies:  do they relate to underlying disease and outcome? The Charité Emergency Medicine Study (CHARITEM).
abstract: OBJECTIVE
  To evaluate the relationship between chief complaints and their underlying diseases and outcome in medical emergency departments (EDs).
  
  
  METHODS
  All 34 333 patients who attended two of the EDs of the Charité Berlin over a 1-year period were included in the analysis. Data were retrieved from the hospital information system. For study purposes, the chief complaint (chest pain, dyspnoea, abdominal pain, headache or 'none of these symptoms') was prospectively documented in an electronic file by the ED-physician. Documentation was mandatory.
  
  
  RESULTS
  The majority of patients (66%) presented with 'none of these symptoms', 11.5% with chest pain, 11.1% with abdominal pain and 7.4% with dyspnoea. In total, 39.4% of all patients were admitted to the hospital. The leading diagnosis was acute coronary syndrome (50.7%) for chest pain in-patients and chronic obstructive pulmonary disease (16.5%) and heart failure (16.1%) for in-patients with dyspnoea. The causes of abdominal pain in in-patients were of diverse gastrointestinal origin (47.2%). In-hospital mortality of in-patients was 4.7%. Patients with chest pain had significantly lower in-hospital mortality (0.9%) than patients with dyspnoea (9.4%) and abdominal pain (5.1%).
  
  
  CONCLUSIONS
  The majority of emergency patients lack diagnosis-specific symptoms. Chief complaints help preselect patients but must not be mistaken as disease specific. Mortality largely differs depending on the chief complaint. In chest pain patients, standardized processes may be one factor that explains the low mortality in this group.
authors.affiliation: Department of Emergency Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Mockel
authors.forename: Julia
authors.initials: J
authors.lastname: Searle
authors.forename: Reinhold
authors.initials: R
authors.lastname: Muller
authors.forename: Anna
authors.initials: A
authors.lastname: Slagman
authors.forename: Harald
authors.initials: H
authors.lastname: Storchmann
authors.forename: Philipp
authors.initials: P
authors.lastname: Oestereich
authors.forename: Werner
authors.initials: W
authors.lastname: Wyrwich
authors.forename: Angela
authors.initials: A
authors.lastname: Ale-Abaei
authors.forename: Joern O
authors.initials: JO
authors.lastname: Vollert
authors.forename: Matthias
authors.initials: M
authors.lastname: Koch
authors.forename: Rajan
authors.initials: R
authors.lastname: Somasundaram
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000453:epidemiology*; D000328:Adult; D000367:Age Factors; D000368:Aged; D015984:Causality; D002637:Chest Pain / Q000175:diagnosis / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D004417:Dyspnea / Q000175:diagnosis / Q000453:epidemiology*; D004635:Emergency Medicine; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany; D006261:Headache / Q000175:diagnosis / Q000453:epidemiology; D017052:Hospital Mortality / Q000639:trends; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D015996:Survival Rate