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Non–Specific Clinical Presentations are Not Prognostic and do not Anticipate Hospital Length of Stay or Resource Utilization

Published:February 16, 2021DOI:https://doi.org/10.1016/j.ejim.2021.02.004

      Highlights

      • Non-specific presentations represent 17.4% of presentations.
      • No difference was seen in mortality between specific and non-specific presentations.
      • No difference was seen in length of stay for specific and non-specific presentations.

      Abstract

      Aim

      To investigate whether a specific (SP) or non-specific (NSP) clinical presentation, predicts prognosis and in-hospital resource utilization in emergency medical admissions.

      Methods

      We studied admissions over 5 years (2015–2019) and classified the symptom presentation as SP or NSP. The predictive capacity of the NSP category was related to 30-day in-hospital mortality with a multivariable logistic regression model. Utilization of procedures/services was related to hospital length of stay (LOS) with zero truncated Poisson regression.

      Results

      There were 39,776 admissions in 23,995 patients. A NSP occurred in 18.2% of our top 20 clinical presentations; the top five being shortness of breath (12.8%), ‘unwell’ (7.1%), collapse (4.1%), abdominal pain (3.6%) and headache (2.7%). Baseline demographic characteristics were similar and unrelated to type of presentation; the model adjusted mortality by SP 4.0% (95% CI: 3.8%, 4.2%) or NSP 3.9% (95% CI: 3.5%, 4.4%) was identical. LOS was a dependant quantitative function of procedures/services undertaken; for the top two presentations of shortness of breath (SP) or unwell (NSP) there was no relationship between a SP or NSP presentation and hospital utilization of procedures/services or LOS.

      Conclusion

      Our data suggest no utility for a categorisation of presentations as specific or non-specific in terms of provision of prognostic information nor as an indicator of the pattern of hospital investigation or LOS.

      Keywords

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