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What are nonspecific complaints and what are their causes and outcomes? The common unknown unknowns of medicine

Published:September 27, 2017DOI:https://doi.org/10.1016/j.ejim.2017.09.032
      Pain, breathlessness, bleeding, deranged vital signs and the acute inability to either walk or talk usually mandate immediate hospital admission. All these presentations are associated with a relatively small number of possible diagnoses and are often managed by specific protocols. There are also a large number of other complaints and nonspecific presentations, which often remain medically unexplained, that may prompt hospitalization [
      • Misch F.
      • Messmer A.S.
      • Nickel C.H.
      • et al.
      Impact of observation on disposition of elderly patients presenting to emergency departments with non-specific complaints.
      ]. These presentations include generalized weakness and fatigue, which are among the most frequently reported complaints in emergency care [
      • Safwenberg U.
      • Terent A.
      • Lind L.
      The Emergency Department presenting complaint as predictor of in-hospital fatality.
      ,
      • Bhalla M.C.
      • Wilber S.T.
      • Stiffler K.A.
      • Ondrejka J.E.
      • Gerson L.W.
      Weakness and fatigue in older ED patients in the United States.
      ], diaphoresis, dizzy spells, “funny feelings”, light headedness and many others. Since they can occur in virtually any illness known to man these complaints are not specific for any diagnosis and do not of themselves mandate admission to hospital.

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