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Unplanned readmissions among patients presenting with nonspecific complaints

  • J.J.H. Wachelder
    Correspondence
    Corresponding author at: Department of Internal Medicine, Máxima Medical Centre, 5631 BM Eindhoven/Veldhoven, The Netherlands.
    Affiliations
    Department of Internal Medicine, Máxima Medical Centre, 5631 BM Eindhoven/Veldhoven, The Netherlands

    Maastricht University, CAPHRI School for Public Health and Primary Care, Ageing and Long-Term Care, Maastricht, The Netherlands

    Dept. of Internal Medicine, Division of General Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, the Netherlands
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  • L.S. van Galen
    Affiliations
    Section Acute Medicine, Department of Internal Medicine, VU Medical Centre, Amsterdam, The Netherlands

    Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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  • J. Kellett
    Affiliations
    Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark
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  • C.H. Nickel
    Affiliations
    Emergency Department, University Hospital Basel, Switzerland
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  • H.R. Haak
    Affiliations
    Department of Internal Medicine, Máxima Medical Centre, 5631 BM Eindhoven/Veldhoven, The Netherlands

    Maastricht University, CAPHRI School for Public Health and Primary Care, Ageing and Long-Term Care, Maastricht, The Netherlands

    Dept. of Internal Medicine, Division of General Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, the Netherlands
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  • on behalf of the[email protected] consortium
      Unplanned readmissions are often caused by patients with multiple comorbidities and functional impairment [
      • Greysen S.R.
      • Stijacic Cenzer I.
      • Auerbach A.D.
      • Covinsky K.E.
      Functional impairment and hospital readmission in Medicare seniors.
      ]. This subgroup partly consists out of patients presenting with nonspecific complaints. It is known that patients presenting with such complaints are a vulnerable population and characterized by their high comorbidity, polypharmacy and functional impairment [
      • Nemec M.
      • Koller M.T.
      • Nickel C.H.
      • Maile S.
      • Winterhalder C.
      • Karrer C.
      • et al.
      Patients presenting to the emergency department with non-specific complaints: the Basel Non-specific Complaints (BANC) study.
      ]. These patients typically complain of “weakness and fatigue” and if they have a serious illness it is either not recognised or recognised too late, resulting in more adverse events and poorer outcomes when compared to patients with specific complaints such as “chest pain” [
      • Nemec M.
      • Koller M.T.
      • Nickel C.H.
      • Maile S.
      • Winterhalder C.
      • Karrer C.
      • et al.
      Patients presenting to the emergency department with non-specific complaints: the Basel Non-specific Complaints (BANC) study.
      ,
      • Rutschmann O.T.
      • Chevalley T.
      • Zumwald C.
      • Luthy C.
      • Vermeulen B.
      • Sarasin F.P.
      Pitfalls in the emergency department triage of frail elderly patients without specific complaints.
      ,
      • Djarv T.
      • Castren M.
      • Martenson L.
      • Kurland L.
      Decreased general condition in the emergency department: high in-hospital mortality and a broad range of discharge diagnoses.
      ,
      • Safwenberg U.
      • Terent A.
      • Lind L.
      The emergency department presenting complaint as predictor of in-hospital fatality.
      ,
      • Wachelder J.J.H.
      • Stassen P.M.
      • Hubens L.P.A.M.
      • Brouns S.H.A.
      • Lambooij S.L.E.
      • Dieleman J.P.
      • et al.
      Elderly emergency patients presenting with non-specific complaints: characteristics and outcomes.
      ]. More readmissions could intensify the already poor prognosis in this vulnerable patient group [
      • Wachelder J.J.H.
      • Stassen P.M.
      • Hubens L.P.A.M.
      • Brouns S.H.A.
      • Lambooij S.L.E.
      • Dieleman J.P.
      • et al.
      Elderly emergency patients presenting with non-specific complaints: characteristics and outcomes.
      ]. Although it is known that patients presenting with nonspecific complaints often do not receive appropriate care during their initial admission which potentially increase their risk of readmission [
      • Nemec M.
      • Koller M.T.
      • Nickel C.H.
      • Maile S.
      • Winterhalder C.
      • Karrer C.
      • et al.
      Patients presenting to the emergency department with non-specific complaints: the Basel Non-specific Complaints (BANC) study.
      ,
      • Misch F.
      • Messmer A.S.
      • Nickel C.H.
      • Gujan M.
      • Graber A.
      • Blume K.
      • et al.
      Impact of observation on disposition of elderly patients presenting to emergency departments with non-specific complaints.
      ], little research has been published in this area.

      Keywords

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