Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland.
Int J Clin Pract. 2021 May;75(5):e14070. doi: 10.1111/ijcp.14070. Epub 2021 Feb 15.
The predictive power of chief complaints reported at presentation to the emergency department (ED) is well known. However, there is a lack of research on the coherence of patient versus physician reported chief complaints. The aim of this study was to determine the rate of disagreement between patients and physicians regarding chief complaint and its significance for the prediction of the outcomes number of resources used during ED work-up, hospitalisation, ICU admission, in-hospital mortality and hospital length of stay.
In this secondary analysis of a study conducted over a time course of 9 weeks, consecutive emergency patients and their physicians were independently asked to report the chief complaint upon presentation. The two reports were assessed for pair-wise agreement.
Of 6722 emergency patients (mean age 53.3, 46.8% female), the median number of symptoms reported by patients was two and one reported by physicians. The rate of disagreement on chief complaints was 32.6%. Disagreement was associated with a higher number of resources (β = 0.24; CI, 0.18, 0.31, P <.001) and hospitalisation (OR = 1.31; CI, 1.16, 1.48, P <.001), using multivariable analyses. Patient factors associated with disagreement were age (OR = 1.01; CI, 1.01, 1.01, P <.001), number of patient reported symptoms (OR = 1.27; CI, 1.23, 1.32, P <.001) and male gender (OR = 1.12; 1.01, 1.25, P =.0285).
Disagreement on chief complaint between patient and physician may be an early marker for a complex work-up, requiring more resources and hospitalisations. The relevance of this finding is the newly identified signal of chief complaint replacement. It is easy to identify and should generate attention, as it affects a certain phenotype (older male patients with higher numbers of complaints).
在急诊科就诊时报告的主要症状具有良好的预测能力。然而，关于患者和医生报告的主要症状之间的一致性的研究还很缺乏。本研究旨在确定患者和医生对主要症状的报告是否存在差异，并探讨这种差异对预测资源利用情况（急诊科检查、住院、重症监护病房入院、住院死亡率和住院时间）的意义。
在这项历时 9 周的研究的二次分析中，连续的急诊患者及其医生在就诊时被独立要求报告主要症状。评估了两份报告的一致性。
在 6722 名急诊患者中（平均年龄 53.3 岁，46.8%为女性），患者报告的症状中位数为 2 个，医生报告的症状中位数为 1 个。主要症状不一致的比例为 32.6%。不一致与更多的资源利用（β=0.24；CI，0.18，0.31，P<.001）和住院（OR=1.31；CI，1.16，1.48，P<.001）有关，这是多变量分析的结果。与不一致相关的患者因素包括年龄（OR=1.01；CI，1.01，1.01，P<.001）、患者报告的症状数量（OR=1.27；CI，1.23，1.32，P<.001）和男性性别（OR=1.12；1.01，1.25，P=.0285）。
患者和医生对主要症状的报告不一致可能是复杂检查的早期标志物，需要更多的资源和住院治疗。这一发现的意义在于新发现的主要症状替换信号。它很容易被识别出来，应该引起关注，因为它影响到特定的表型（年龄较大的男性患者，报告的症状数量较多）。
