Chief complaints in medical emergencies: do they relate to underlying disease and outcome? The Charité Emergency Medicine Study (CHARITEM)
Martin M et al. European Journal of Emergency Medicine: April 2013 - Volume 20 - Issue 2 - p 103–108 doi: 10.1097/MEJ.0b013e328351e609
Abstract
Objectives: 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%).
Conclusion: 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.