Systematically assessed symptoms as outcome predictors in emergency patients

Area of Science:

• Emergency Medicine
• Clinical Epidemiology
• Prognostic Research

Background:

• Symptom assessment is established for predicting mortality in non-surgical emergency patients.
• The prognostic value of a systematic, unscreened symptom assessment in all emergency patients remains unknown.

Purpose of the Study:

• To investigate the association between systematically assessed symptoms and patient outcomes in an all-comer emergency department population.
• To determine the prognostic value of symptom presentation for predicting mortality and other adverse outcomes.

Main Methods:

• Prospective data collection over six weeks at a tertiary hospital's emergency department (ED).
• Systematic symptom assessment using a comprehensive questionnaire for all consecutive ED patients.
• Analysis of associations between presenting symptoms and outcomes including hospitalization, intensive care unit (ICU) referral, and in-hospital and one-year mortality.

Main Results:

• A total of 3960 patients were studied, with a median of two symptoms per patient.
• One-year mortality varied significantly based on presenting symptoms, ranging from 0% to 14.4%.
• Dyspnea (14.4% one-year mortality) and weakness (9.2% one-year mortality) were identified as significant predictors of one-year mortality.

Conclusions:

• Systematic symptom assessment in emergency departments provides valuable prognostic information.
• Weakness, previously unrecognized, is a significant predictor of one-year mortality alongside dyspnea.
• Findings can enhance risk stratification protocols to reduce adverse patient outcomes.