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Presenting Complaints (presenting + complaints)

Distribution by Scientific Domains

Medical Sciences	87%

Kinds of Presenting Complaints

common presenting complaints

Selected Abstracts

A System for Grouping Presenting Complaints: The Pediatric Emergency Reason for Visit Clusters

ACADEMIC EMERGENCY MEDICINE, Issue 8 2005
MSCE, Marc H. Gorelick MD
Abstract Objectives: To develop a set of chief complaint groupings for pediatric emergency department (ED) visits that is comprehensive, parsimonious, clinically sensible, and evidence-based. Methods: Investigators derived candidate chief complaint clusters and ranked them a priori into three perceived severity categories. Pediatric visits were extracted from the National Hospital Ambulatory Medical Care Survey (NHAMCS); data for years 1998 and 2000 (n= 13,186) were used for derivation and data for year 1999 (n= 5,365) were used for validation. Visits were assigned to clusters based on the recorded complaints; clusters were combined to ensure adequate numbers for analysis (minimum n= 20), and the clusters were reviewed for clinical sensibility. Resource utilization was categorized in three levels: routine (examination only), ED treatment (tests or therapy in the ED but not admitted), and admission. Area under the receiver-operating characteristic (ROC) curve (AUC) was used to demonstrate the discriminative ability of the clusters in predicting resource use. Results: There were 463 unique complaints in the derivation database; 95 (20%) had a single associated visit. Fifty-two clusters were generated; only 2.4% of complaints were classified as other. The eight most common clusters encompassed 52% of the visits. The top five were fever (11%), extremity pain/injury, vomiting, cough, and trauma (unspecified). Complaint clusters were associated with actual resource utilization: for routine care, the AUC was 0.73 (0.74 in the validation set), and for admission, the AUC was 0.77 (0.74 in the validation set). Both resource utilization and triage classification increased with increased expert severity ranking (test for trend, p < 0.001). Conclusions: The proposed Pediatric Emergency Reason for Visit Cluster (PERC) system is a comprehensive yet parsimonious, clinically sensible means of categorizing pediatric ED complaints. The PERC system's association with measures of acuity and resource utilization makes it a potentially useful tool in epidemiologic and health services research. [source]

Differences in Long-term Mortality for Different Emergency Department Presenting Complaints

ACADEMIC EMERGENCY MEDICINE, Issue 1 2008
Urban Safwenberg MD
Abstract Objectives:, To characterize long-term mortality based on previous emergency department (ED) presenting complaints. Methods:, The authors followed, for 10 years, all of the 12,667 nonsurgical patients visiting an ED during 1995/1996. Differences in standardized mortality ratio (SMR) depending on presenting complaints were then investigated. Results:, During follow-up, 5,324 deaths occurred (mortality rate 6.6 per 100 person-years at risk), giving a SMR of 1.33 (95% CI = 1.30 to 1.37, p < 0.001) when compared with the expected mortality in the catchment area. Different presenting complaints were associated with different long-term mortality rates, independent of age and gender (p < 0.0001). The subjects with seizures had the highest SMR (2.62, 95% CI = 2.13 to 3.22) followed by intoxications (2.51, 95% CI = 2.11 to 2.98), asthmalike symptoms (1.84, 95% CI = 1.65 to 2.06), and hyperglycemia (1.67, 95% CI = 1.42 to 1.95). The largest complaint group, chest pain, had a 20% higher mortality rate than the background population (95% CI = 1.13 to 1.26). Patients with a discharge diagnosis of myocardial infarction, but without chest pain as the presenting complaint, had an increased long-term mortality (hazard ratio [HR] 1.70, 95% CI = 1.15 to 2.42) compared to the group with chest pain. In contrast, stroke patients without strokelike symptoms had a reduced mortality (HR 0.74, 95% CI = 0.65 to 0.84) compared to patients with strokelike symptoms. Conclusions:, Long-term age- and gender-adjusted mortality is the highest with seizures out of 33 presenting complaints and differs markedly between different ED admission complaints. Furthermore, depending on the admission complaint, long-term mortality differs within the same discharge diagnosis. Hence, the presenting complaint adds unique information to the discharge diagnosis regarding long-term mortality in nonsurgical patients. [source]

Overview of interventions to enhance primary-care provider management of patients with substance-use disorders

DRUG AND ALCOHOL REVIEW, Issue 5 2009
PETER ANDERSON
Abstract Issues. Despite the evidence for the effectiveness and cost-effectiveness of interventions to manage substance use disorders, which are common presenting complaints in primary care, primary-care providers find managing substance use disorders a difficult business. This paper provides an overview of the evidence for interventions, including training and education programmes, in enhancing the management of alcohol- and tobacco-use disorders by health-care providers. Approach. The Cochrane Library and the database of the Cochrane Effective Practice and Organisation of Care Group were searched for answers to five questions: (i) Can education and training increase the involvement of primary care providers? (ii) Can education and training cause harm? (iii) Can education and training be enhanced with support and other organisational factors? (iv) Can finance systems change provider behaviour? and (v) Is political support needed? Key Findings. Education and training can increase the involvement of primary-care providers in managing alcohol- and tobacco-use disorders, with the impact enhanced by additional support and other organisational factors. There is some evidence that if education and training does not take account of providers' attitudes, then harm can be caused. There is limited evidence that finance systems can change provider behaviour, and that comprehensive policy, in which a health sector response is a part, can increase the potential of primary-care management of alcohol- and tobacco-use disorders. Conclusions. Tailored education and training programmes for the management of alcohol- and tobacco-use disorders need to be broadly implemented and embedded in overall comprehensive policies that provide the necessary organisational and financial incentives for enhancing provider behaviour. There is an urgent need to extend the evidence base on the impact of education and training and other strategies to increase the involvement of providers in managing substance-use disorders.[Anderson P. Overview of interventions to enhance primary-care provider management of patients with substance-use disorders. Drug Alcohol Rev 2009;28:567,574] [source]

An undergraduate paediatric curriculum based on clinical presentations and ,key features'

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 11 2008
Ralph Pinnock
Aim: We wanted to develop and define an undergraduate paediatric curriculum in a way that would facilitate the development of clinical reasoning. Method: We sent a series of four questionnaires to paediatricians in New Zealand to explore their perceptions of common presenting complaints for an undergraduate paediatrics curriculum. The final group of paediatricians consulted had no further suggestions to add to the twenty five presentations that had already been listed. Further consultation lead to the determination of the knowledge and skills students' require in order to assess and manage these presentations. Result: We have defined with wide consultation, a framework for an undergraduate paediatric curriculum suitable for New Zealand. Conclusions: When consulting with a range of experts it can be difficult to reach agreement. By describing the curriculum as a series of presenting complaints and using the concept of ,key features' we were able to reach agreement on the content and details of an undergraduate curriculum for paediatrics. [source]

Gastric Neoplasia in Horses

JOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 5 2009
S.D. Taylor
Background: Gastric neoplasia of horses is incompletely described. Objective: Provide history, clinical signs, and clinicopathological and pathological findings associated with gastric neoplasia in horses. Animals: Twenty-four horses with gastric neoplasia. Methods: Retrospective study. History, clinical signs, and clinicopathological and pathologic findings in horses diagnosed histologically with gastric neoplasia were reviewed. Results: Horses ranged in age from 9 to 25 years (median 18 years at presentation). There was no apparent breed or sex predisposition. The most common presenting complaints were inappetance (17/24), weight loss (14/24), lethargy (7/24), hypersalivation (7/24), colic (5/24), and fever (5/24). The most consistent clinical signs were tachypnea (10/19), decreased borborygmi (8/19), and low body weight (7/17). Useful diagnostic tests included rectal examination, routine blood analysis, gastroscopy, abdominocentesis, and transabdominal ultrasound examination. Anemia was the most common hematologic abnormality encountered (7/19), and hypercalcemia of malignancy was seen in 4/16 horses. Squamous cell carcinoma was the most common tumor identified (19/24), and was most often (14/19) found as a single ulcerated, necrotic mass in the nonglandular portion of the stomach. Other gastric neoplasms encountered were leiomyoma (n=2), mesothelioma (n=1), adenocarcinoma (n=1), and lymphoma (n=1). Metastatic neoplasia was found in 18/23 horses. The median time from onset of clinical signs to death was 4 weeks, and all horses died or were euthanized because of gastric neoplasia. Conclusions: Squamous cell carcinoma is the most common primary gastric neoplasia in horses. The survival time after diagnosis of gastric neoplasia in horses is short. [source]

Laparoscopic Diagnosis of Pancreatic Disease in Dogs and Cats

JOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 6 2008
C.B. Webb
Background: Histopathology is the gold standard for the diagnosis of pancreatic disease. Laparoscopy offers a minimally invasive route by which to obtain pancreatic biopsies. Hypothesis: Laparoscopy is a safe and effective technique for evaluating the pancreas in small animal patients. Animals: Medical records of 18 dogs and 13 cats examined between 1999 and 2007 that underwent laparoscopy during which observation or biopsy of the pancreas was recorded. Methods: The database for the Laparoscopy Laboratory at Colorado State University was searched for records that contained "pancreatitis,""pancreas," or "pancreatic." The presenting complaints, imaging studies, and histopathologic findings of animals were recorded. All hospital admissions were searched for animals with the same presenting complaints and of those it was determined which animals had exploratory surgery and their pancreas biopsied. Results: Thirteen cats and 18 dogs underwent laparoscopy for presumptive pancreatic disease or had the appearance of the pancreas described, pancreatic biopsies obtained, or both. In 14 animals a laparoscopic biopsy of the pancreas resulted in a histopathologic diagnosis when the sonographic findings or the gross assessment failed to do so. In 35% of the animals a biopsy of the pancreas was not obtained despite findings consistent with pancreatic disease. Those animals examined for vomiting or anorexia were significantly more likely to have a biopsy of the pancreas obtained through laparoscopy versus surgery (P < .0001). Conclusions and Clinical Importance: Laparoscopy and pancreatic biopsy is useful for evaluation of pancreatic disease. [source]

Intestinal Neoplasia in Horses

JOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 6 2006
S.D. Taylor
Background:Intestinal neoplasia of horses is inadequately described. Hypothesis:Intestinal neoplasia of horses has characteristic clinicopathologic features. Animals:Thirty-four horses with intestinal neoplasia. Methods:Retrospective study. Results:Anamnesis, clinical signs, clinicopathologic and pathologic findings in 34 adult horses diagnosed histologically with intestinal neoplasia were reviewed. The horses ranged in age from 2 to 30 years (mean 16.6 years at presentation). The Arabian breed was most represented and there was no sex predisposition. The most common presenting complaints were weight loss, colic, anorexia, and fever. The most consistent clinical signs were poor body condition, tachycardia, tachypnea, fever, and diarrhea. Useful diagnostic tools included rectal examination, routine blood analyses, abdominocentesis, ultrasonographic examination, rectal biopsy, and exploratory laparotomy. Alimentary lymphoma was the most common intestinal neoplasia identified, followed by adenocarcinoma and smooth muscle tumors. The small intestine was the most common segment of intestine affected for all neoplasms. Intestinal neoplasia was diagnosed antemortem in 13 of 34 (38%) horses. The median time from onset of clinical signs to death or euthanasia was 1.9 months. The discharge rate was 15%. Although the longest survival was observed in horses with jejunal adenocarcinoma, all horses were eventually euthanized because of intestinal neoplasia. Conclusions: Arabian horses were 4.5 times more likely to have intestinal neoplasia diagnosed than were other breeds. [source]

Measurement of protection afforded by ultraviolet-absorbing window film using an in vitro model of photodamage

LASERS IN SURGERY AND MEDICINE, Issue 4 2006
Eric F. Bernstein MD
Abstract Background and Objectives The effects of chronic sun damage including telangiectasias, solar lentigos, rhytides, enlarged pores, sagging skin, and pre-cancerous and cancerous growths are among the most common presenting complaints in a dermatologist's office. These changes are often worse on the driver's side of the face, emphasizing the role of UVA exposure received while driving in producing these changes. This study was undertaken to measure the ability of car window glass alone and in combination with ultraviolet (UV)-absorbing film to reduce UV-damage as measured using an established in vitro model of photoprotection. Study Design Materials and Methods Using the 3T3 neutral red uptake photoprotection assay with solar simulating radiation (SSR) administered by a xenon arc solar simulator, we measured the photoprotection ability of auto glass, window film that filters UV radiation, and the combination of window film and auto glass. Results As measured by the 3T3 neutral red uptake photoprotection assay, auto glass reduced cell death from SSR by 29%, while window film reduced it 90%, and the combination of auto glass and film reduced cell death by 93%, when compared to unfiltered SSR. Conclusions Window film that filters UV radiation results in dramatic reductions in cytotoxicity when measured by the neutral red uptake photoprotection assay. Widespread use of window film provides an ever-present barrier to ultraviolet A (UVA) exposure and could potentially reduce the detrimental effects of UVA, including photoaging, skin cancer, and ocular damage, such as cataracts. In addition, such film is essential for patients suffering from conditions sensitive to UV radiation, such as lupus erythematosis. Lasers Surg. Med. 38:337,342, 2006. © 2006 Wiley-Liss, Inc. [source]

Triage Presenting Complaint Descriptions Bias Emergency Department Waiting Times

ACADEMIC EMERGENCY MEDICINE, Issue 8 2008
Martin J. Dutch BMedSci
Abstract Objectives:, The authors aimed to determine whether certain emergency department (ED) triage "presenting complaint" descriptions are associated with shorter or longer waiting times, when compared with matched controls. Methods:, This was a retrospective, analytical study in three tertiary referral EDs. Data relating to adult patients with Australasian National Triage Scale (NTS) Category 3,5 complaints, who presented over 1 year, were accessed. A pilot study of 25 emergency physicians (EPs) identified five most liked and five most disliked presenting complaints. For each liked or disliked complaint, "cases" were identified using key words and phrases in the triage presentation description. For each case, the previous presentation at that institution with the same NTS category was used as a "control." Cases and controls were compared for waiting time and proportions seen within the Australasian College for Emergency Medicine (ACEM)-recommended waiting times. Results:, Data on 28,566 case,control pairs were examined. Compared to their controls, three of the five most liked complaints (dislocations, fractures, and palpitations) had significantly shorter waiting times, and significantly more were seen within the recommended waiting times (p < 0.05). In contrast, three of the five most disliked complaints (dizziness, constipation, and back pain) had significantly longer waiting times, and significantly fewer were seen within the recommended waiting times (p < 0.05). Other presenting complaints showed similar, although nonsignificant, trends. Conclusions:, Waiting times for patients with certain presenting complaints are significantly associated with triage presenting complaint descriptions. It is likely that these descriptions allow EPs to selectively seek or avoid patients with liked or disliked complaints, respectively. The impact of this for patients and ED flow needs investigation. [source]

Differences in Long-term Mortality for Different Emergency Department Presenting Complaints

Paresthesia and hypesthesia in the dorsum of the foot as the presenting complaints of a ganglion cyst of the foot

CLINICAL ANATOMY, Issue 5 2010
Diogo Casal
Abstract Although ganglion cysts of the foot represent a substantial amount of lumps in this region, they rarely cause peripheral nerve symptoms. We describe the clinical case of a 43-year-old female with complaints in the previous three months of hypesthesia and paresthesia in the anterior portion of the medial half of the dorsum of her left foot that extended into the first interdigital cleft. She associated the start of her neurological symptoms to the appearance of a lump in the dorsum of the foot. A presumptive diagnosis of compression of the medial branch of the deep fibular nerve and of the medial dorsal cutaneous nerve in the dorsum of the foot by a ganglion cyst was made. Ultrasonography confirmed the cystic nature of the lesion and surgery allowed complete excision of a mass arising from the joint between the medial and intermediate cuneiform bones that was compressing the deep fibular nerve and the medial dorsal cutaneous nerve. Pathological examination confirmed that the lesion was a cystic ganglion. As far as the authors know, the simultaneous compression of the medial branch of the deep fibular nerve and of the medial dorsal cutaneous nerve in the dorsum of the foot by a ganglion cyst has not been described before. Clin. Anat. 23:606,610, 2010. © 2010 Wiley-Liss, Inc. [source]

Illness and exposure to negative life experiences in adolescence: two sides of the same coin?

ACTA PAEDIATRICA, Issue 3 2004
A study of 15-year-olds in Oslo, Norway
Aim: To investigate associations between negative life experiences and common illnesses among adolescents. Methods: Cross-sectional questionnaire study carried out at all lower secondary schools (10 grade) in Oslo, Norway, during 2000 and 2001 (n= 8316 pupils). Different negative life experiences and illnesses were addressed. Results: The participation rate was 88%. Among reported negative life experiences last year were a pressure felt to succeed (62%), death of a close person (26%), exposure to physical violence (22%), bullying at school (15%) and sexual violation (4%). A large number of the pupils had some chronic illness: hay fever (38%), eczema (29%) and asthma (13%). Reported illnesses the previous 12 month were: headache (56%), painful neck or shoulders (35%), sore throat at least three times (15%), lower respiratory tract infection (9%) and mental problems for which help was sought (7%). During the week prior to the survey, 26% of all girls had symptoms of a depressive disorder, while this applied to 10% of all boys. Fifty-three percent of the boys (29% of the girls) who had depressive symptoms had been exposed to physical violence. Sexually violated boys had a high probability for seeking help for mental problems (OR = 4.9) and for frequent episodes of sore throat (OR = 2.5). Corresponding odds ratios for girls were 1.7 and 2.5, respectively. Conclusion: Common illnesses in adolescence are significantly associated with negative life experiences. In clinical encounters with adolescents not only should the presenting complaints be addressed, but also other common illnesses and relevant background factors such as negative life events. [source]

Paediatric utilization of a general emergency department in a developing country

ACTA PAEDIATRICA, Issue 8 2003
AY Goh
Aim: Knowledge of the spectrum and frequencies of paediatric emergencies presenting to an emergency department (ED) of individual developing countries is vital in optimizing the quality of care delivered locally. Methods: A prospective 6 wk review of all paediatric (< 18y) attendees to an urban ED was done, with patient age, presenting complaints, diagnoses, time of arrival and disposition recorded. Results: Complete data were available on 1172 patients, with an age range of 4 d to 18 y (mean ± SD 6.9 ± 5.6 y); 43% were aged ,4 y. The main presenting complaints were injuries (26.9%), fever (24%) and breathing difficulties (16.6%). The most common diagnosis was minor trauma (24.2%), with soft-tissue injuries predominating (80.6%). The other diagnoses were asthma (12.6%), upper respiratory infections (12.1%), other infections (12.1%) and gastroenteritis (11.8%). Equal proportions of patients were seen throughout the day. 25% of patients were admitted. Young age (<1 y); presence of past medical history, general practitioner referrals, diagnosis of bronchiolitis and pneumonia were significantly associated with risk of admission. Conclusion: A wide spectrum of paediatric illnesses was seen in the ED, with an overrepresentation of young children. This supports the decision to have either a separate paediatric ED or paediatric residents on the staff. The training curricula should emphasize the management of paediatric trauma, infections and asthma. Alternatively, developing guidelines for the five most common presenting complaints would account for 82% of all attendees and could be directed towards all staff on the ED. [source]

Predictive Validity of a Computerized Emergency Triage Tool

ACADEMIC EMERGENCY MEDICINE, Issue 1 2007
Sandy L. Dong MD
Abstract Background Emergency department (ED) triage prioritizes patients on the basis of the urgency of need for care. eTRIAGE is a Web-based triage decision support tool that is based on the Canadian Triage and Acuity Scale (CTAS), a five level triage system (CTAS 1 = resuscitation, CTAS 5 = nonurgent). Objectives To examine the validity of eTRIAGE on the basis of resource utilization and cost as measures of acuity. Methods Scores on the CTAS, specialist consultations, computed-tomography use, ED length of stay, ED disposition, and estimated ED and hospital costs (if the patient was subsequently admitted to hospital) were collected for each patient over a six month period. These data were queried from a database that captures all regional ED visits. Correlations between CTAS score and each outcome were measured by using logistic regression models (categorical variables), univariate analysis of variance (continuous variables), and the Kruskal-Wallis analysis of variance (costs). A multivariate regression model that used cost as the outcome was used to identify interaction between the variables presented. Results Over the six month study, 29,524 patients were triaged by using eTRIAGE. When compared with CTAS level 3, the odds ratios for consultation, CT scan, and admission were significantly higher in CTAS 1 and 2 and were significantly lower in CTAS 4 and 5 (p < 0.001). When compared with CTAS levels 2,5 combined, the odds ratio for death in CTAS 1 was 664.18 (p < 0.001). The length of stay also demonstrated significant correlation with CTAS score (p < 0.001). Costs to the ED and hospital also correlated significantly with increasing acuity (median costs for CTAS levels in Canadian dollars: CTAS 1 =$2,690, CTAS 2 =$433, CTAS 3 =$288, CTAS 4 =$164, CTAS 5 =$139, and p < 0.001). Significant interactions between the data collected were found in a multivariate regression model, although CTAS score remained highly associated with costs. Conclusions Acuity measured by eTRIAGE demonstrates excellent predictive validity for resource utilization and ED and hospital costs. Future research should focus on specific presenting complaints and targeted resources to more accurately assess eTRIAGE validity. [source]