Nonspeciﬁc complaints in emergency medicine: contribution of clinical chemistry and diagnostic imaging to ﬁnal diagnosis. An observational study
1Emergency Department, University Hospital Basel, 4031 Basel, Switzerland
DOI: 10.22514/sv.2021.096 Vol.17,Issue 4,July 2021 pp.49-54
Submitted: 02 March 2021 Accepted: 06 April 2021
Published: 08 July 2021
Objective: To determine the contribution of history, physical examination, clinical chemistry, and diagnostic imaging to the validated final diagnosis in patients presenting with nonspecific complaints to the emergency department (ED).
Methods: This is a secondary analysis of Basel Non-specific Complaints (BANC), a multicentre prospective observational study. A final diagnosis was validated for every patient after a 30 days follow-up. A team of experts rated the contribution of the emergency work-up, and of clinical chemistry, diagnostic imaging, specialist consultation, and other exams to the final diagnosis.
Results: 612 non-trauma patients with NSC were prospectively included. After exclusion of 19 patients due to protocol violation or missing information, 593 patients were analysed. 412/593 (69%) validated final diagnoses were attributed to the ED work-up, and 181 (31%) to subsequent work-up by internal medicine, geriatrics, or outpatient clinics. Clinical chemistry was judged to be decisive for 300/593 (51%), and imaging for 106/593 (18%) of all final diagnoses. Chest radiography was decisive in 50 (8%), cranial computed tomography or magnetic resonance imaging in 21 (4%), and chest computed tomography in 10 (2%) cases.
Conclusion: Clinical chemistry and imaging contribute substantially to the diagnoses of patients presenting to the ED with NSC. However, post-ED-workup including consultations by specialists (e.g., neurology, geriatrics, psychiatry) were decisive for almost a third of all final diagnoses.
Nonspecific complaints; Emergency medicine; Clinical chemistry; Diagnostic imaging; Physical examination
Annalea Patzen,Noemi R. Simon,Andrea S. Jauslin,Christian H. Nickel,Roland Bingisser. Nonspeciﬁc complaints in emergency medicine: contribution of clinical chemistry and diagnostic imaging to ﬁnal diagnosis. An observational study. Signa Vitae. 2021. 17(4);49-54.
 Walls R, Hockberger R, Gausche-Hill M. Rosen’s emergency medicine-concepts and clinical practice. Philadelphia, PA: Elsevier. 2017.
 Siegenthaler W. Differential diagnosis in internal medicine: from symptom to diagnosis. New York, NY: Thieme Medical Publishers. 2007.
 Nemec M, Koller MT, Nickel CH, Maile S, Winterhalder C, Karrer C, et al. Patients presenting to the emergency department with non–specific complaints: the Basel Non-Specific Complaints (BANC) study. Academic Emergency Medicine. 2010; 17: 284–292.
 Liu SW, Sri–On J, Tirrell GP, Nickel C, Bingisser R. Serious conditions for ED elderly fall patients: a secondary analysis of the Basel non-specific complaints study. American Journal of Emergency Medicine. 2016; 34: 1394–1399.
 Wachelder JJH, Stassen PM, Hubens LPAM, Brouns SHA, Lambooij SLE, Dieleman JP, et al. Elderly emergency patients presenting with non-specific complaints: characteristics and outcomes. PLoS ONE. 2017; 12: e0188954.
 Kuster T, Nickel CH, Jenny MA, Blaschke LL, Bingisser R. Combina-tions of symptoms in emergency presentations: prevalence and outcome. Journal of clinical medicine. 2019; 8: 345.
 Sauter TC, Capaldo G, Hoffmann M, Birrenbach T, Hautz SC, Kämmer JE, et al. Non–specific complaints at emergency department presentation result in unclear diagnoses and lengthened hospitalization: a prospective observational study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2018; 26: 1–7.
 Fukui T. Relative contribution of history-taking, physical examination, and stat laboratory test to diagnosis in chest pain patients. Japanese Journal of Public Health. 1990; 37: 569–575.
 Mitro P, Kirsch P, Valočik G, Murín P. Clinical history in the diagnosis of the cardiac syncope—the predictive scoring system. Pacing and Clinical Electrophysiology. 2011; 34: 1480–1485.
 Eskelinen M, Lipponen P. Usefulness of history-taking in non-specific abdominal pain: a prospective study of 1333 patients with acute abdominal pain in Finland. In Vivo. 2012; 26: 335–339.
 Verwoerd AJH, Peul WC, Willemsen SP, Koes BW, Vleggeert-Lankamp CLAM, el Barzouhi A, et al. Diagnostic accuracy of history taking to assess lumbosacral nerve root compression. Spine Journal. 2014; 14: 2028–2037.
 Wells PS, Anderson DR, Rodger M, Ginsberg JS, Kearon C, Gent M, et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thrombosis and Haemostasis. 2000; 83: 416–420.
 Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. American Journal of Medicine. 1994; 96: 200–209.
 Leuppi JD, Dieterle T, Koch G, Martina B, Tamm M, Perruchoud AP, et al. Diagnostic value of lung auscultation in an emergency room setting. Swiss Medical Weekly. 2005; 135: 520–524.
 Becker RE. Remebering Sir. William Osler 100 years after his death: what can we learn from his legacy? Lancet. 2014; 384: 2260–2263.
 Peng A, Rohacek M, Ackermann S, Ilsemann–Karakoumis J, Ghanim L, Messmer AS, et al. The proportion of correct diagnoses is low in emergency patients with nonspecific complaints presenting to the emergency department. Swiss Medical Weekly. 2015; 145: w14121.
 Grossmann FF, Nickel CH, Christ M, Schneider K, Spirig R, Bingisser R. Transporting clinical tools to new settings: cultural adaptation and validation of the emergency severity index in German. Annals of Emergency Medicine. 2011; 57: 257–264.
 Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases. 1987; 40: 373–383.
 White DK, Wilson JC, Keysor JJ. Measures of adult general functional status: SF-36 physical functioning subscale (PF–10), Health Assess-ment Questionnaire (HAQ), Modified Health Assessment Questionnaire (MHAQ), Katz Index of Independence in activities of daily living, Functional Independence Measure (FIM), and Osteoarthritis-Function-Computer Adaptive Test (OA-Function-CAT). Arthritis Care Research. 2011; 63: S297–S307.
 Stiell IG, Wells GA, Vandemheen K, Clement C, Lesiuk H, Laupacis A, et al. The Canadian CT head rule for patients with minor head injury. Lancet. 2001; 357: 1391–1396.
 Klok FA, Mos ICM, Nijkeuter M, Righini M, Perrier A, Le Gal G, et al. Simplification of the revised geneva score for assessing clinical probability of pulmonary embolism. Archives of Internal Medicine. 2008; 168: 2131–2136.
 Khasriya R, Khan S, Lunawat R, Bishara S, Bignall J, Bignal J, et al. The inadequacy of urinary dipstick and microscopy as surrogate markers of urinary tract infection in urological outpatients with lower urinary tract symptoms without acute frequency and dysuria. Journal of Urology. 2010; 183: 1843–1847.
 Cortes-Penfield NW, Trautner BW, Jump RLP. Urinary tract infection and asymptomatic bacteriuria in older adults. Infectious Disease Clinics of North America. 2017; 31: 673–688.
 Biggel M, Heytens S, Latour K, Bruyndonckx R, Goossens H, Moons P. Asymptomatic bacteriuria in older adults: the most fragile women are prone to long-term colonization. BMC Geriatrics. 2019; 19: 1–11.
 Hill SA, Booth RA, Santaguida PL, Don-Wauchope A, Brown JA, Oremus M, et al. Use of BNP and NT-proBNP for the diagnosis of heart failure in the emergency department: a systematic review of the evidence. Heart Failure Reviews. 2014; 19: 421–438.
 Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Medicine. 2013; 39: 165–228.
 Hoeboer SH, van der Geest PJ, Nieboer D, Groeneveld ABJ. The diagnostic accuracy of procalcitonin for bacteraemia: a systematic review and meta-analysis. Clinical Microbiology and Infection. 2015; 21: 474–481.
 Tan M, Lu Y, Jiang H, Zhang L. The diagnostic accuracy of procalcitonin and C-reactive protein for sepsis: a systematic review and meta-analysis. Journal of Cellular Biochemistry. 2019; 120: 5852–5859.
 Walker HK, Hall WD, Hurst JW. Clinical methods: the history, physical, and laboratory examinations. 3rd edn. Boston: Butterworths. 1990.
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