Chief complaints and computed tomography results in the emergency department: a three-year retrospective cohort study.

BACKGROUND: Computed tomography (CT) is frequently performed in the patients who admitted to the emergency department (ED), discharged but returned to ED within 72 h. It is unknown whether the main complaints of patients assist physicians to use CT effectively. This study aimed to find the association between chief complaints and the CT results. METHODS: This three-year retrospective cohort study was conducted in the ED of a tertiary medical center. Adult patients who returned to the ED after the index visit were included from 2019 to 2021. Demographics, pre-existing diseases, chief complaints, and CT region were recorded by independent ED physicians. A logistic regression model with an odds ratio (OR) and 95% confidence interval (CI) was used to determine the relationship between chief complaints and positive CT results. RESULTS: In total, 7,699 patients revisited ED after the index visit; 1,202 (15.6%) received CT. The top chief complaints in patients who received CT were abdominal pain, dizziness, and muscle weakness. Patients with abdominal pain or gastrointestinal symptoms had a significantly higher rate of positive abdominopelvic CT than those without it (OR 2.83, 95% CI 1.98-4.05, p < 0.001), while the central nervous system and cardiopulmonary chief complaints were not associated (or negatively associated) with new positive CT findings. CONCLUSION: Chief complaints of patients on revisit to the ED are associated with different yields of new findings when CT scans of the chest, abdomen and head are performed. Physicians should consider these differential likelihoods of new positive findings based on these data.

Characterizing COVID-19: A chief complaint based approach.

BACKGROUND: The COVID-19 pandemic has inundated emergency departments with patients exhibiting a wide array of symptomatology and clinical manifestations. We aim to evaluate the chief complaints of patients presenting to our ED with either suspected or confirmed COVID-19 to better understand the clinical presentation of this pandemic. METHODS: This study was a retrospective computational analysis that investigated the chief complaints of all confirmed and suspected COVID-19 cases presenting to our adult ED (patients aged 22 and older) using a variety of data mining methods. Our study employed descriptive statistics to analyze the set of complaints that are most common, hierarchical clustering analysis to provide a nuanced way of identifying complaints that co-occur, and hypothesis testing identify complaint differences among age differences. RESULTS: A quantitative analysis of 5015 ED visits of COVID-suspected patients (1483 confirmed COVID-positive patients) identified 209 unique chief complaints. Of the 209 chief complaints, fever and shortness of breath were the most prevalent initial presenting symptoms. In the subset of COVID-19 confirmed positive cases, we discovered seven distinct clusters of presenting complaints. Patients over 65 years of age were more likely to present with weakness and altered mental status. CONCLUSIONS: Our research highlights an important aspect of the evaluation and management of COVID-19 patients in the emergency department. Our study identified most common chief complaints, chief complaints differences across age groups, and 7 distinct groups of COVID-19 symptoms. This large-scale effort to classify the most commonly reported symptoms in ED patients provides public health officials and providers with data for identifying COVID-19 cases.

Comparison of the clinical characteristics of TAFRO syndrome and idiopathic multicentric Castleman disease in general internal medicine: a 6-year retrospective study.

BACKGROUND: Although thrombocytopenia, anasarca, fever, reticulin fibrosis and organomegaly (TAFRO) syndrome was first described as a variant of idiopathic multicentric Castleman disease (CD), patients with TAFRO syndrome demonstrate more aggressive clinical features. Because these patients may present with fever of unknown origin, general physicians need to recognise its characteristic laboratory data and clinical features during hospitalisation. AIMS: to describe the features, symptoms and characteristics of TAFRO syndrome and to compare them to those of idiopathic CD. METHODS: This was a retrospective study of patients with histopathologically confirmed TAFRO syndrome and idiopathic multicentric CD who were diagnosed and managed between April 2012 and June 2018 in a Japanese university hospital's General Medicine Department. RESULTS: We found that the hospitalisations were significantly longer among patients with TAFRO syndrome compared to those with idiopathic CD (median: 87 days; range: 34-236 days vs median: 30 days; range: 13-59 days; P < 0.01). Patients with TAFRO syndrome were more likely to present with fever, abdominal pain and elevated inflammatory markers and be misdiagnosed with an infectious disease during the first hospital visit. Approximately 40% of patients with TAFRO syndrome had no radiographically enlarged lymph nodes. CONCLUSIONS: TAFRO syndrome may present as an infectious disease with an aggressive clinical course. Our study highlights the importance of giving significance to chief complaints and laboratory data. Physicians need to recognise the clinical and laboratory features of this disease to avoid missing this potentially fatal disorder.

Homeless patients tend to have greater psychiatric needs when presenting to the emergency department.

INTRODUCTION: Homeless patients tend to visit Emergency Departments (EDs) more frequently than the non-homeless population. The goal of this study was to assess differences in chief complaint, medical conditions, and disposition between homeless patients compared to non-homeless patients presenting to an urban ED. METHODS: This was a retrospective cohort of homeless patients ages ≥18 years compared to non-homeless controls from January 1, 2017 to December 31, 2017. Exclusion criteria were as follows: direct admission to hospital floor, repeat visits, or leaving without being seen. The primary endpoint of this study was to assess differences in chief complaint of homeless versus non-homeless patients upon presentation to the ED. Our secondary endpoints included differences in ED utilization between the two groups, in terms of length of stay, ambulance use, diagnosis, and disposition. RESULTS: Homeless patients were more likely present to the ED for a psychiatric evaluation (homeless group 34% vs. non-homeless group 4%, p < 0.01) and have a history of a psychiatric diagnosis (56% vs. 10%, p < 0.01) compared to non-homeless controls. Homeless patients also tended to require more ambulance transport (46% vs. 16%, p < 0.01). More homeless patients were transferred to a psychiatric facility (40% vs. 1%, p < 0.01), while the majority of non-homeless patients were discharged home (50% vs. 93%, p < 0.01). CONCLUSION: This study found that homeless patients had a significantly higher association with psychiatric diagnoses and greater ED utilization than non-homeless. This suggests the importance of increased access to consistent psychiatric care and follow up within the homeless population.

Chief complaint classification with recurrent neural networks.

Syndromic surveillance detects and monitors individual and population health indicators through sources such as emergency department records. Automated classification of these records can improve outbreak detection speed and diagnosis accuracy. Current syndromic systems rely on hand-coded keyword-based methods to parse written fields and may benefit from the use of modern supervised-learning classifier models. In this paper, we implement two recurrent neural network models based on long short-term memory (LSTM) and gated recurrent unit (GRU) cells and compare them to two traditional bag-of-words classifiers: multinomial naïve Bayes (MNB) and a support vector machine (SVM). The MNB classifier is one of only two machine learning algorithms currently being used for syndromic surveillance. All four models are trained to predict diagnostic code groups as defined by Clinical Classification Software, first to predict from discharge diagnosis, and then from chief complaint fields. The classifiers are trained on 3.6 million de-identified emergency department records from a single United States jurisdiction. We compare performance of these models primarily using the F1 score, and we measure absolute model performance to determine which conditions are the most amenable to surveillance based on chief complaint alone. Using discharge diagnoses, the LSTM classifier performs best, though all models exhibit an F1 score above 96.00. Using chief complaints, the GRU performs best (F1 = 47.38), and MNB with bigrams performs worst (F1 = 39.40). We also note that certain syndrome types are easier to detect than others. For example, chief complaints using the GRU model predicts alcohol-related disorders well (F1 = 78.91) but predicts influenza poorly (F1 = 14.80). In all instances, the RNN models outperformed the bag-of-words classifiers suggesting deep learning models could substantially improve the automatic classification of unstructured text for syndromic surveillance.

The usefulness of chief complaints to predict severity, ventilator dependence, treatment option, and short-term outcome of patients with Guillain-Barré syndrome: a retrospective study.

BACKGROUND: It remains an urgent need for early recognition of disease severity, treatment option and outcome of Guillain-Barré syndrome (GBS). The chief complaint may be quickly obtained in clinic and is one of the candidates for early predictors. However, studies on the chief complaint are still lacking in GBS. The aim of the study is to describe the components of chief complaints of GBS patients, and to explore association between chief complaints and disease severity/treatment option/outcome of GBS, so as to aid the early prediction of the disease course and to assist the clinicians to prescribe an optimal early treatment. METHODS: A total of 523 GBS patients admitted to the First Hospital of Jilin University from 2003 to 2013 were enrolled for retrospective analysis. The data of chief complaints, clinical manifestations, and treatment options, etc. were collected. The clinical severity was evaluated by the Medical Research Council sum score and the Hughes Functional Grading Scale. The prognosis at 6 month after discharge was described by modified Erasmus GBS outcome score. The clinic GBS severity evaluation scale (CGSES), a newly established model in our study, was used to explore the role of chief complaints to predict intravenous immunoglobulin (IVIg). RESULTS: The major components of the chief complaints of GBS patients were weakness, numbness, pain, cranial nerve involvement, dyspnea, ataxia and autonomic dysfunction. Chief complaint of weakness was a predictor of severe disease course and poor short-term outcome, while chief complaint of numbness and cranial nerve involvement were promising predictors. Cranial nerve involvement was the predictor of ventilator dependence. The percentages of 366 GBS patients, who need IVIg treatment at nadir with CGSES ranging from 1 to 4, were 50.00, 67.34, 80.61, and 90.67%, respectively. CONCLUSIONS: Chief complaints are clinic predictors of disease severity, ventilator dependence and short-term outcome. IVIg treatment during hospitalisation could be predicted in clinic using CGSES score.

Neuro-pediatric emergencies: clinical profile and outcomes.

Pediatric neurological emergencies are a significant concern, often leading to high rates of admission to pediatric intensive care units and increased mortality rates. In Saudi Arabia, the emergency department (ED) is the main entry point for most patients in the healthcare system. This study aimed to provide a comprehensive overview of pediatric neurology visits to the ED, analyzing patient demographics, clinical presentations, and outcomes. The retrospective study was conducted at a large tertiary care center and examined 960 pediatric patients with neurological emergencies out of 24,088 pediatric ED visits. The study population consisted mainly of male participants (56.5%) and 43.5% female participants, with a mean age of 5.29 ± 4.19 years. School-age children (6-12 years) represented the largest population group (29.1%), and over a third of patients were triaged as 'resuscitation' (n = 332, 34.6%). Seizures (n = 317, 33.0%) and postictal states (n = 187, 19.5%) were the most common reasons for seeking emergency care, accounting for over half of all cases. There were statistically significant differences in provisional diagnosis and chief complaints across different age groups (P >0.001 and P <0.001, respectively). The most common outcome was discharge (n = 558; 58.1%), and the mean length of stay was 10.56 ± 20.33 hours. Neuro-emergencies in pediatrics are a concern and a leading cause of mortality, morbidities, and increased hospital visits. The observed variations in presentation and outcomes across age groups further emphasize the importance of tailored approaches.

When It's Not Allergic Rhinitis: Clinical Signs to Raise a Patient's Suspicion for Chronic Rhinosinusitis.

OBJECTIVE: To identify predictors of chronic rhinosinusitis (CRS) in patients presenting with the chief complaint of nasal allergies. STUDY DESIGN: Cross-sectional study. SETTING: Tertiary care, academic center. METHODS: Clinical and demographic characteristics were collected from participants who were patients presenting with the chief complaint of nasal allergies. From all participants, a 22-item Sinonasal Outcome Test (SNOT-22) was collected, and a modified Lund-Kennedy endoscopy score was calculated from nasal endoscopy. Association was sought between having CRS and variables of clinical and demographic characteristics, SNOT-22, and endoscopy score. RESULTS: A total of 219 patients were recruited and 91.3% were diagnosed with allergic rhinitis; 45.2% were also diagnosed with CRS. Approximately half of the patients with CRS reported no intranasal corticosteroid usage. Having CRS was associated with male sex (odds ratio [OR] = 2.29, 95% confidence interval [CI]: 1.30-4.04, P = .004), endoscopy score (OR = 1.96, 95% CI: 1.59-2.42, P < .001), and the SNOT-22 nasal subdomain score (OR = 1.07, 95% CI: 1.03-1.11, P = .001) related to SNOT-22 items: "need to blow nose," "thick nasal discharge," "sense of taste/smell," and "blockage/congestion of nose." At least moderate (item score ≥3) "blockage/congestion of nose" or "thick nasal discharge," mild "need to blow nose" (item score ≥2) or very mild decreased "sense of taste/smell" (item score ≥1), and any nasal endoscopy findings (endoscopy score ≥1) were statistically significant predictors of CRS. CONCLUSION: Moderate or more severe nasal obstruction or discharge symptoms, any decreased sense of smell/taste, or positive nasal endoscopy findings in patients believing they have allergic rhinitis should prompt further evaluation of CRS to avoid delays in treatment.

Implementation of Chief Complaint-Based Clinical Reasoning Training in Periodontal Internships.

BACKGROUND: The gap between theoretical knowledge and clinical skills highlights the need for clinical reasoning training curriculum in periodontal education, especially in periodontal internships. This study aims to develop a Chief Complaint-Based Clinical Reasoning Training (CCB-CRT) program and evaluate its impact on periodontal interns' clinical reasoning abilities and overall performance. METHODS: The CCB-CRT program was developed based on eight common chief complaints (CCs) identified through surveys of periodontal specialists and an analysis of patient visit data from a university-affiliated hospital's periodontal clinic. The study involved a comparison between a control group of fifth-year dental students (2021) and a CCB-CRT group (2022). Both groups completed an 8-week training course. The CCB-CRT group received additional training focused on the 8 common CCs, using student-led discussions, flipped classroom, mind mapping, and presentations. Evaluation criteria included overall performance, disease diagnosis and treatment plan, misdiagnosis rates, and students' satisfaction. RESULTS: After 1 year of CCB-CRT implementation, participants in the CCB-CRT group showed substantial improvements in overall performance, diagnostic accuracy, and satisfaction compared to traditional teaching methods. The program enhanced students' understanding of theoretical knowledge, improved their interpretation of clinical manifestations and examination results, and enhanced their clinical reasoning skills and diagnostic accuracy. CONCLUSIONS: The successful application of the CCB-CRT program in periodontology education demonstrates its efficacy in improving clinical reasoning skills and diagnostic efficiency among students. The structured approach facilitates the transition from theoretical knowledge to practical application, contributing to better patient care in periodontal practice.

Emergency department visit data for rapid detection and monitoring of norovirus activity, United States.

Noroviruses are the leading cause of gastroenteritis in the United States, but timely measures of disease are lacking. BioSense, a national-level electronic surveillance system, assigns data on chief complaints (patient symptoms) collected during emergency department (ED) visits to 78 subsyndromes in near real-time. In a series of linear regression models, BioSense visits mapped by chief complaints of diarrhea and nausea/vomiting subsyndromes as a monthly proportion of all visits correlated strongly with reported norovirus outbreaks from 6 states during 2007-2010. Higher correlations were seen for diarrhea (R = 0.828-0.926) than for nausea/vomiting (R = 0.729-0.866) across multiple age groups. Diarrhea ED visit proportions exhibited winter seasonality attributable to norovirus; rotavirus contributed substantially for children <5 years of age. Diarrhea ED visit data estimated the onset, peak, and end of norovirus season within 4 weeks of observed dates and could be reliable, timely indicators of norovirus activity.

Evaluation of Age, Chief Complaint, Diagnosis, and Treatment Done during the First Dental Visit among Children in an Academic Dental Institution in Southern Kerala, India.

Context: A regular and timely first dental visit plays a cardinal role in the future oral health of the child. It is used to begin preventive and corrective interventions in dental care. Aim: To evaluate the age, chief complaint, diagnosis, and treatment done during the first dental visit among children in an academic dental institution in southern Kerala, India. Materials and Methods: A descriptive cross sectional retrospective survey was conducted between January and June 2022 among children in an academic dental institution in southern Kerala, India. The hospital records at the Pushpagiri College of Dental Sciences were examined to obtain the child's age, chief complaint, diagnosis, and treatment done during the first dental visit among children. Statistical Analysis: The data were expressed in frequencies and percentages. Results: The records of 1000 children (680 male and 320 female) were examined. Most children (40%) who came for their first dental visit were aged between 4 and 6 years. Only 16% of children aged 0-3 years came for their first dental visit. Pain and sensitivity (50%) and tooth decay (17%) were the most common chief complaints among children. Dental caries (45%) and pulpal pathology (38%) were the most common diagnoses among children. The most common treatments done were glass ionomer cement restorations (32%), followed by prescribing medications (29%). No treatment was required for 16% of the children. Only a minority (3%) of the children received preventive treatments. Conclusions: The first dental visit was delayed, and most children sought treatment only during apparent acute symptoms. There is a high prevalence of oral disease burden and underutilization of preventive dental care among children. Education of parents on the value of first dental visits and the usage of preventative dental care in children is crucial.

The Geospatial Analysis of Patients Seeking Dental Care at a Private Dental Institution in Chennai, India.

Background and aim Assessing the priority of the patient towards dental needs while considering the distance traveled by them is important to improve a dental service. The purpose of this study was to rank the patients' felt needs for dental care in the private dental institution in order of importance. The objective is to count the number of patients with various major complaints and compare how far patients traveled for various treatment plans tailored to their individual needs in a private dental institution. Material and methods The sample consisted of all new patients who sought dental care at Saveetha Dental College and Hospital, Chennai, India, between January 1, 2022, and December 31, 2022. Retrospective data from the dental information archive system was gathered on their primary chief complaint and residential address. Frequency distribution of patients with different chief complaints was found. The mean and standard deviation of distance traveled by patients for different treatment plans was done using descriptive statistics using IBM SPSS Statistics for Windows, Version 22 (Released 2013; IBM Corp., Armonk, New York, United States). Results The priority order of the felt need by the patients was dental pain in which n=1299 (15.4%) > missing teeth with n=1224 (14.59%) > deposit/stains/halitosis n=1149 (13.6%) > shaking tooth n=936 (11.15%) > irregularly placed/proclined teeth n=852 (10.15%) > dislodged crown/restoration n=843 (10.05%) > tooth decay/discoloration n=759 (9%) > general checkup n=723 (8.6%) > swelling/ulcer/wound n=246 (2.93%) > painful jaw/facial pain/difficult mouth opening n=198 (2.26%). In 2022, most patients requiring caries preventive measure (0.8%) located at the mean distance of 10.75±2.2 km, while patients requiring scaling (16.9%), dental filling (10.9%), endodontic management (18.6%), extraction (23.7%), prosthetic replacement (13.9%), orthodontic management (10.9%), and facial pain management (2.2%) were located at the mean distance of 14.49±8.2 km, 10.28±6.25 km, 18.43±13.9 km, 14.29±6.6 km, 23.49±11.8 km, 11.76±8.13 km, and 45.32±17.35 km, respectively. Conclusion More number of patients traveled long distances even more than 50 km for painful tooth decay. Also, lots of patients were found to seek replacement of their missing teeth next to pain. Thus, dental pain and missing teeth form a major priority of the patient's felt dental need. Also, the patient had traveled a lot for facial pain management compared to other treatment needs which shows the lack of facial pain management practice by dental care centers near their local residence.

Are 5-level triage systems improved by using a symptom based approach?-a Danish cohort study.

BACKGROUND: Five-level triage systems are being utilized in Danish emergency departments with and without the use of presenting symptoms. The aim of this study was to validate and compare two 5-level triage systems used in Danish emergency departments: "Danish Emergency Process Triage" (DEPT) based on a combination of vital signs and presenting symptoms and a locally adapted version of DEPT (VITAL-TRIAGE) using vital signs only. METHODS: This was a retrospective cohort using data from five Danish emergency departments. All patients attending an emergency department during the period of 1 April 2012 until 31 December 2015 were included. Validity of the two triage systems was assessed by comparing urgency categories determined by each triage system with critical outcomes: admission to Intensive care unit (ICU) within 24 h, 2-day mortality, diagnosis of critical illness, surgery within 48 h, discharge within 4 h and length of hospital stay. RESULTS: We included 632,196 ED contacts. Sensitivity for 24-h ICU admission was 0.79 (95% confidence interval 0.78-0.80) for DEPT and 0.44 (0.41-0.47) for VITAL-TRIAGE. The sensitivity for 2-day mortality was 0.69 (0.67-0.70) for DEPT and 0.37 (0.34-0.41) for VITAL-TRIAGE. The sensitivity to detect diagnoses of critical illness was 0.48 (0.47-0.50) for DEPT and 0.09 (0.08-0.10) for VITAL-TRIAGE. The sensitivity for predicting surgery within 48 h was 0.30 (0.30-0.31) in DEPT and 0.04 (0.04-0.04) in VITAL-TRIAGE. Length of stay was longer in VITAL-TRIAGE than DEPT. The sensitivity of DEPT to predict patients discharged within 4 h was 0.91 (0.91-0.92) while VITAL-TRIAGE was higher at 0.99 (0.99-0.99). The odds ratio for 24-h ICU admission and 2-day mortality was increased in high-urgency categories of both triage systems compared to low-urgency categories. CONCLUSIONS: High urgency categories in both triage systems are correlated with adverse outcomes. The inclusion of presenting symptoms in a modern 5-level triage system led to significantly higher sensitivity measures for the ability to predict outcomes related to patient urgency. DEPT achieves equal prognostic performance as other widespread 5-level triage systems.

Calibrating a chief complaint list for low resource settings: a methodologic case study.

BACKGROUND: The chief or presenting complaint is the reason for seeking health care, often in the patient's own words. In limited resource settings, a diagnosis-based approach to quantifying burden of disease is not possible, partly due to limited availability of an established lexicon or coding system. Our group worked with colleagues from the African Federation of Emergency Medicine building on the existing literature to create a pilot symptom list representing an attempt to standardize undifferentiated chief complaints in emergency and acute care settings. An ideal list for any setting is one that strikes a balance between ease of use and length, while covering the vast majority of diseases with enough detail to permit epidemiologic surveillance and make informed decisions about resource needs. METHODS: This study was incorporated as a part of a larger prospective observational study on human immunodeficiency virus testing in Emergency Departments in South Africa. The pilot symptom list was used for chief complaint coding in three Emergency Departments. Data was collected on 3357 patients using paper case report forms. Chief complaint terms were reviewed by two study team members to determine the frequency of concordance between the coded chief complaint term and the selected symptom(s) from the pilot symptom list. RESULTS: Overall, 3537 patients' chief complaints were reviewed, of which 640 were identified as 'potential mismatches.' When considering the 191 confirmed mismatches (29.8%), the Delphi process identified 6 (3.1%) false mismatches and 185 (96.9%) true mismatches. Significant chief-complaint clustering was identified with 9 sets of complaints frequently selected together for the same patient. "Pain" was used 2076 times for 58.7% of all patients. A combination of user feedback and expert-panel modified Delphi analysis of mismatched complaints and clustered complaints resulted in several substantial changes to the pilot symptom list. CONCLUSIONS: This study presented a systematic methodology for calibrating a chief complaint list for the local context. Our revised list removed/reworded symptoms that frequently clustered together or were misinterpreted by health professionals. Recommendations for additions, modifications, and/or deletions from the pilot chief complaint list we believe will improve the functionality of the list in low resource environments.

Prevalence and factors influencing reporting of true periodontal chief complaints: A retrospective analysis.

OBJECTIVES: To investigate the prevalence of true periodontal chief complaints (CC) and the factors affecting their reporting by patients with periodontal diseases (PD). MATERIALS AND METHODS: This cross-sectional study was based on retrospective analysis of available periodontal records. Different personal and demographic variables were obtained from these records including CC, age, gender, working status, past medical/dental history, smoking status and diagnosis. In addition, clinical parameters of plaque index, gingival index, probing pocket depth (PPD), and number of missing teeth. Periodontal CC were retrieved and divided either into true periodontal (bleeding, tooth mobility, and alteration in gingival color/shape) or others (emergency and esthetic-related) CC. RESULTS: A total of 1161 records were included in the final analysis. Results showed that only 287 (24.7%) of patients reported true periodontal CC whereas the remaining 874 (75.3%) patients were not aware about symptoms of PD. Regression modeling indicated that reporting of true CC was positively associated with smoking and PPD but negatively associated with number of missing teeth and gender (male). CONCLUSIONS: Results suggested that recognition of true periodontal CC by the patients was low. Reporting of true periodontal CC was significantly associated with smoking, PPD, female and lower number of missing teeth. These results shed light on the importance of increasing public knowledge about PD which is essential to aid people in recognizing these diseases at early stages.

Initial assessment in emergency departments by chief complaint and respiratory rate.

BACKGROUND: Understanding heterogeneity of the respiratory rate (RR) as a risk stratification marker across chief complaints is important to reduce misinterpretation of the risk posed by outcome events and to build accurate risk stratification tools. This study was conducted to investigate the associations between RR and clinical outcomes according to the five most frequent chief complaints in an emergency department (ED): fever, shortness of breath, altered mental status, chest pain, and abdominal pain. METHODS: This retrospective cohort study examined ED data of all adult patients who visited the ED of a tertiary medical center during April 2018-September 2019. The primary exposure was RR at the ED visit. Outcome measures were hospitalization and mechanical ventilation use. We used restrictive cubic spline and logistic regression models to assess the association of interest. RESULTS: Of 16 956 eligible ED patients, 4926 (29%) required hospitalization; 448 (3%) required mechanical ventilation. Overall, U-shaped associations were found between RR and the risk of hospitalization (eg, using RR = 16 as the reference, the odds ratio [OR] of RR = 32, 6.57 [95% CI 5.87-7.37]) and between RR and the risk of mechanical ventilation. This U-shaped association was driven by patients' association with altered mental status (eg, OR of RR = 12, 2.63 [95% CI 1.25-5.53]). For patients who have fever or shortness of breath, the risk of hospitalization increased monotonously with increased RR. CONCLUSIONS: U-shaped associations of RR with the risk of overall clinical outcomes were found. These associations varied across chief complaints.

Somatic symptoms with psychogenic or psychiatric background: Characteristics and pitfalls.

INTRODUCTION: The characteristics of somatic symptoms seen at the first hospital visit in patients with psychogenic backgrounds remain poorly elucidated till date. METHODOLOGY: A total of 277 patients who visited the Department of General Medicine at a single university hospital with somatic symptoms were prospectively enrolled in this study. The eventual definite diagnoses were classified into the following three groups: non-psychogenic disease (n = 128), psychogenic symptoms (n = 131), and mental illness (n = 18). Subsequently, the chief complaints and other background information of the patient obtained at the first visit were compared among the three groups. RESULTS: More than half of the patient with non-psychogenic diseases (60.2%) presented with a single complaint at their first hospital visit; contrarily, less than half of the patients with psychogenic symptoms (23.7%) or mental illnesses (22.2%) presented with a single complaint at the first visit. Approximately, <10% of the patients with non-psychogenic diseases had four or more multisystemic presentations at the first visit. The results of the receiver operating characteristic curve analysis revealed a fair discriminatory ability of the number of complaints to identify patients with psychogenic diseases or psychiatric backgrounds. Almost half of the non-psychogenic patients with four or more multisystemic presentations were eventually diagnosed with autoimmune-related disorders, such as Sjögren's syndrome or Behçet's disease. In conclusion, the general notion that patients with psychogenic somatic symptoms are likely to present with more complaints than patients with non-psychogenic diseases is correct. However, not a few patients who present with multiple indefinite complaints would certainly have organic diseases such as autoimmune-related disorders or neuromuscular diseases. A careful diagnostic process is required in such patients before attributing their symptoms to psychogenic or psychiatric factors.

Comparison of Chief Complaints and Patient-Reported Symptoms of Treatment-Naive Lung Cancer Patients Before Surgery.

BACKGROUND: Lung cancer patients without chief complaints have been increasingly identified by physical examination. This study aimed to profile and compare chief complaints with patient-reported symptoms of lung cancer patients before surgery. METHODS: Data were extracted from a multicenter, prospective longitudinal study (CN-PRO-Lung 1) in China from November 2017 to January 2020. A comparison between chief complaints and patient-reported symptoms was analyzed using the Chi-squared test. RESULTS: A total of 201 (50.8%) lung cancer patients without chief complaints were found by physical examination at admission, and 195 (49.2%) patients had chief complaints. The top 5 chief complaints were coughing (38.1%), expectoration (25.5%), chest pain (13.6%), hemoptysis (10.6%), and shortness of breath (5.3%). There were significantly more patients with chief complaints of coughing (38.1% vs 15.0%, P <0.001) and pain (20.5% vs 6.9%, P<0.001) than those with the same symptoms rated ≥4 via MD Anderson Symptom Inventory‒Lung Cancer (MDASI-LC). There were less patients with chief complaints of fatigue (1.8% vs 10.9%, P<0.001), nausea (0.3% vs 2.5%, P=0.006), and vomiting (0.3% vs 1.8%, p=0.032) than those with the same symptoms rated ≥4 via MDASI-LC. In patients without chief complaints, the five most common moderate to severe patient-reported symptoms were disturbed sleep (19.5%), distress (13.5%), dry mouth (13%), sadness (12%), and difficulty remembering (11.1%). CONCLUSION: Symptoms of lung cancer patients not included in the chief complaint could be identified via a patient-reported outcome instrument, suggesting the necessity of implementing the patient-reported outcome assessment before lung cancer surgery for better patient care.

Differences and similarities between emergency department syndromic surveillance and hospital discharge data for nonfatal drug overdose.

PURPOSE: Emergency department syndromic surveillance and hospital discharge data have been used to detect and monitor nonfatal drug overdose, yet few studies have assessed the differences and similarities between these two data sources. METHODS: The Centers for Disease Control and Prevention Drug Overdose Surveillance and Epidemiology system data from 14 states were used to compare these two sources at estimating monthly overdose burden and trends from January 2018 through December 2019 for nonfatal all drug, opioid-, heroin-, and stimulant-involved overdoses. RESULTS: Compared to discharge data, syndromic data captured 13.3% more overall emergency department visits, 67.8% more all drug overdose visits, 15.6% more opioid-involved overdose visits, and 78.8% more stimulant-involved overdose visits. Discharge data captured 18.9% more heroin-involved overdoses. Significant trends were identified for all drug (Average Monthly Percentage Change [AMPC]=1.1, 95% CI=0.4,1.8) and stimulant-involved overdoses (AMPC=2.4, 95% CI=1.2,3.7) in syndromic data; opioid-involved overdoses increased in both discharge and syndromic data (AMPCDischarge=0.9, 95% CI=0.2,1.7; AMPCSyndromic=1.9, CI=1.1,2.8). CONCLUSIONS: Results demonstrate that discharge data may be better for reporting counts, yet syndromic data are preferable to detect changes quickly and to alert practitioners and public health officials to local overdose clusters. These data sources do serve complementary purposes when examining overdose trends.