Dear Editor,
With great interest we have read the recent systematic review on “Nonspecific Complaints (NSCs) in the Emergency Department” [1] and would like to comment on two key aspects: First, we agree that NSCs should be considered a major emergency presentation. Different nomenclatures have been used in the past, such as “homecare impossible”, “unexplained symptoms”, “general disability”, “atypical symptoms”, and “nonspecific functional decline” (for review, see [2]). This diversity has not been helpful for a clinical definition or clinical research on nonspecific complaints [3]. Second, the authors did not present any definition of nonspecific complaints, but included studies using varying definitions from very different settings, such as Emergency Medical Services (EMS).
However, NSCs were first defined by Nemec et al [4] This original definition was based on the inclusion of patients in need of external resources, excluding patients with life-saving interventions. The original BANC studies excluded hemodynamically unstable patients (i.e. Emergency Severity Index (ESI) level 1; patients in need of life-saving interventions), as the work-up of shock is standardized. Similarly, the lowest triage categories were excluded as well, as these patients can usually be managed as see-and-treat outpatients and are not at risk for adverse outcomes. The rationale to focus on these patients is the lack of a standardized work-up, the high use of resources, and the risk of adverse outcomes [5–8]. All publications originating from the prospective multicenter Basel Nonspecific Complaints (BANC) cohorts used the above definition of NSCs [9–12], but other studies have used varying criteria to define NSCs [13]. There is an inherent difference regarding inclusion criteria between the studies considered by the present systematic review, e.g., some of the included studies were retrospective, and one study [14] has used a post-hoc classification of nonspecific complaints [15].
Surprisingly, the original publication by Nemec et al. [4], coining the term, was excluded from the present systematic review. We believe that this was based on arbitrary inclusion criteria. The argument to exclude studies deliberately focusing on certain triage categories does not seem valid unless an alternative, stringent definition of NSCs is used.
Therefore, we suggest that further research should be based on a common definition of nonspecific complaints in emergency presentations, in order to reduce heterogeneity of studies.
Acknowledgments
NA
Authors’ contributions
The author(s) read and approved the final manuscript.
Author’s information
Both authors are on twitter: @EDbingi, @replynickel.
Availability of data and materials
NA
Ethics approval and consent to participate
NA
Consent for publication
NA
Competing interests
We perform symptom-oriented research and are editors of www.medstandards.com
Abbreviations
Nonspecific complaints
Basel nonspecific complaints study
Emergency severity index
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
1. Kemp, K; Mertanen, R; Lääperi, M; Niemi-Murola, L; Lehtonen, L; Castren, M. Nonspecific complaints in the emergency department - a systematic review. Scand J Trauma Resusc Emerg Med; 2020; 28,
2. Bingisser, R; Nickel, CH. The last century of symptom-oriented research in emergency presentations--have we made any progress?. Swiss Med Wkly; 2013; 143, w13829. [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24089196]
3. Nickel, CH; Malinovska, A; Bingisser, R. Should weakness be subsumed to nonspecific complaints?-correspondence in response to Bhalla et al. Am J Emerg Med; 2015; 33,
4. Nemec, M; Koller, MT; Nickel, CH; Maile, S; Winterhalder, C; Karrer, C; Laifer, G; Bingisser, R. Patients presenting to the emergency department with non-specific complaints: the Basel non-specific complaints (BANC) study. Acad Emerg Med; 2010; 17,
5. Nickel, CH; Messmer, AS; Geigy, N; Misch, F; Mueller, B; Dusemund, F; Hertel, S; Hartmann, O; Giersdorf, S; Bingisser, R. Stress markers predict mortality in patients with nonspecific complaints presenting to the emergency department and may be a useful risk stratification tool to support disposition planning. Acad Emerg Med; 2013; 20,
6. Nickel, CH; Ruedinger, JM; Messmer, AS; Maile, S; Peng, A; Bodmer, M; Kressig, RW; Kraehenbuehl, S; Bingisser, R. Drug-related emergency department visits by elderly patients presenting with non-specific complaints. Scand J Trauma Resusc Emerg Med; 2013; 21, 15. [DOI: https://dx.doi.org/10.1186/1757-7241-21-15]
7. Peng, A; Rohacek, M; Ackermann, S; Ilsemann-Karakoumis, J; Ghanim, L; Messmer, AS; Misch, F; Nickel, CH; Bingisser, R. The proportion of correct diagnoses is low in emergency patients with nonspecific complaints presenting to the emergency department. Swiss Med Wkly; 2015; 145, w14121. [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25741894]
8. Nickel, CH; Ruedinger, J; Misch, F; Blume, K; Maile, S; Schulte, J; Köhrle, J; Hartmann, O; Giersdorf, S; Bingisser, R. Copeptin and peroxiredoxin-4 independently predict mortality in patients with nonspecific complaints presenting to the emergency department. Acad Emerg Med; 2011; 18,
9. Karakoumis, J; Nickel, CH; Kirsch, M; Rohacek, M; Geigy, N; Müller, B; Ackermann, S; Bingisser, R. Emergency presentations with nonspecific complaints-the burden of morbidity and the Spectrum of underlying disease: nonspecific complaints and underlying disease. Medicine (Baltimore); 2015; 94,
10. Jenny, MA; Hertwig, R; Ackermann, S; Messmer, AS; Karakoumis, J; Nickel, CH; Bingisser, R. Are mortality and acute morbidity in patients presenting with nonspecific complaints predictable using routine variables?. Acad Emerg Med; 2015; 22,
11. Malinovska, A; Nickel, CH; Bingisser, R. Trajectories of survival in patients with nonspecific complaints. Eur J Intern Med; 2018; 55, pp. e17-e18. [DOI: https://dx.doi.org/10.1016/j.ejim.2018.06.020]
12. Nickel, CH; Messmer, AS; Ghanim, L; Ilsemann-Karakoumis, J; Giersdorf, S; Hertel, S; Ernst, S; Geigy, N; Bingisser, R. Adrenomedullin for risk stratification of emergency patients with nonspecific complaints: an interventional multicenter pilot study. Medicine (Baltimore); 2016; 95,
13. Quinn, K; Herman, M; Lin, D; Supapol, W; Worster, A. Common diagnoses and outcomes in elderly patients who present to the emergency department with non-specific complaints. Cjem.; 2015; 17,
14. Sauter, TC; Capaldo, G; Hoffmann, M; Birrenbach, T; Hautz, SC; Kämmer, JE; Exadaktylos, AK; Hautz, WE. Non-specific complaints at emergency department presentation result in unclear diagnoses and lengthened hospitalization: a prospective observational study. Scand J Trauma Resusc Emerg Med; 2018; 26,
15. Bingisser, R; Nickel, CH. Comment to: non-specific complaints at emergencydepartment presentation result in uncleardiagnoses and lengthened hospitalization: a prospective observational study. Scand J Trauma Resusc Emerg Med; 2018; 26,
You have requested "on-the-fly" machine translation of selected content from our databases. This functionality is provided solely for your convenience and is in no way intended to replace human translation. Show full disclaimer
Neither ProQuest nor its licensors make any representations or warranties with respect to the translations. The translations are automatically generated "AS IS" and "AS AVAILABLE" and are not retained in our systems. PROQUEST AND ITS LICENSORS SPECIFICALLY DISCLAIM ANY AND ALL EXPRESS OR IMPLIED WARRANTIES, INCLUDING WITHOUT LIMITATION, ANY WARRANTIES FOR AVAILABILITY, ACCURACY, TIMELINESS, COMPLETENESS, NON-INFRINGMENT, MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. Your use of the translations is subject to all use restrictions contained in your Electronic Products License Agreement and by using the translation functionality you agree to forgo any and all claims against ProQuest or its licensors for your use of the translation functionality and any output derived there from. Hide full disclaimer
© The Author(s) 2020. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.
Abstract
[...]the authors did not present any definition of nonspecific complaints, but included studies using varying definitions from very different settings, such as Emergency Medical Services (EMS). The argument to exclude studies deliberately focusing on certain triage categories does not seem valid unless an alternative, stringent definition of NSCs is used. [...]we suggest that further research should be based on a common definition of nonspecific complaints in emergency presentations, in order to reduce heterogeneity of studies. Availability of data and materials NA Ethics approval and consent to participate NA Consent for publication NA Competing interests We perform symptom-oriented research and are editors of www.medstandards.com AbbreviationsNSCs Nonspecific complaintsBANC study Basel nonspecific complaints studyESI Emergency severity index Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
You have requested "on-the-fly" machine translation of selected content from our databases. This functionality is provided solely for your convenience and is in no way intended to replace human translation. Show full disclaimer
Neither ProQuest nor its licensors make any representations or warranties with respect to the translations. The translations are automatically generated "AS IS" and "AS AVAILABLE" and are not retained in our systems. PROQUEST AND ITS LICENSORS SPECIFICALLY DISCLAIM ANY AND ALL EXPRESS OR IMPLIED WARRANTIES, INCLUDING WITHOUT LIMITATION, ANY WARRANTIES FOR AVAILABILITY, ACCURACY, TIMELINESS, COMPLETENESS, NON-INFRINGMENT, MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. Your use of the translations is subject to all use restrictions contained in your Electronic Products License Agreement and by using the translation functionality you agree to forgo any and all claims against ProQuest or its licensors for your use of the translation functionality and any output derived there from. Hide full disclaimer
Details
1 University Hospital Basel, University of Basel, Emergency Department, Basel, Switzerland