The Assessment of a Patient's Chief Complaints by Emergency Medical Technicians and Residents of an Emergency Department

PURPOSE: Addressing a patient's chief complaint is the first and key element of treating patients. This study determined the effectiveness of emergency medical technician and residents of an emergency department in addressing a patient's chief complaints. If emergency and hospital personnel misunderstand the chief symptoms of patients it could result in erroneous transport and treatment, thus losing precious time in finding the proper treatment. METHODS: A retrospective chart review study was performed in 1137 patients (at least 18 years of age), who visited one university hospital, for a period of 3 months. Patients who were did not undergo trauma, addiction, and cardiac arrest were included. RESULTS: A total of 150 cases (13.2%) did not match the chief symptoms reported by 119 emergency medical personnel and emergency medicine residents. Systemic symptoms, nervous system symptoms, and psychiatric symptoms were the main categories inconsistently assessed. The rank and certification of emergency medical technicians did not make a difference, but older patients (59 years of age or older) were statistically different. The assessment fo chief symptoms by an emergency medical resident tended to be more accurate than assessment of emergency medical technicians in the final diagnosis. CONCLUSION: Systemic symptoms, nervous symptoms, and psychiatric symptoms, were chief complaines easily misreported for older patients. This likely reflects a difficulty in the evaluation of obscure symptoms in older patients. It will require specific additional training programs to improve the response to these chief complaints.

The Complaints of Weak Patients / 日本東洋医学雑誌

We examined the complaints of adult patients with ‘weak’ sho symptoms using their first-visit medical questionnaires. Our subjects were 39 patients (3 males and 36 females) who fatigued easily, and who had a weak constitution with stress and the changing of seasons.Over 60% of these ‘weak’ patients complained of excessive sensitivity to cold. The majority had stiff shoulders, a stiff neck, low back pain, sleeplessness, headache, fatigue of the eyes and vertigo. Their gastrointestinal constitutions were poor because of over eating.Although we understood many of the complains these ‘weak’ patients had through their medical questionnaires, their chief complaints were various. We hope these results are useful in understanding treatments for patients with ‘weak’ sho.

The Complaints of Weak Patients-Using Medical Questionnaires- / 日本東洋医学雑誌

We examined the complaints of adult patients with ‘weak’ <I>sho</I> symptoms using their first-visit medical questionnaires. Our subjects were 39 patients (3 males and 36 females) who fatigued easily, and who had a weak constitution with stress and the changing of seasons.<BR>Over 60% of these ‘weak’ patients complained of excessive sensitivity to cold. The majority had stiff shoulders, a stiff neck, low back pain, sleeplessness, headache, fatigue of the eyes and vertigo. Their gastrointestinal constitutions were poor because of over eating.<BR>Although we understood many of the complains these ‘weak’ patients had through their medical questionnaires, their chief complaints were various. We hope these results are useful in understanding treatments for patients with ‘weak’ <I>sho</I>.

Effect of Weather on Chief Complaints and Disorders of Outpatients / 日本温泉気候物理医学会雑誌

We investigated the effect of season or meteorological phenomena, on chief complaints and disorders of outpatients, by way of clarification of relationship between weather and health. This study covered the new outpatients of our division, and carried out on February '03 and June '03 (February: 72 males, 106 females, aged 49.9±18.5, June: 98 males, 109 females, aged 47.6±19.5). We categorized their clinical data into chief complaints (pain, headache, discomforts, fever, cough, vertigo/stagger, palsy) and disorders (gastrointestinal, mental, inflammatory, orthopedic, infection, respiratory, circulatory, tumorous, urinary, autoimmune/allergic, dental/oral, gynecological), then, compared the clinical data of February with June, in terms of seasonal disease. Additionally, we investigated the relationship between weather data and clinical data of February and June, from a perspective of meteoropathy. The average of meteorological phenomena (air pressure, air temperature, relative humidity, velocity of wind, day length, rainfall level) of a week before first visit, were used as weather data. The main results of analysis about seasonal disease, showed that the complaint of discomfort were more frequent in June than February (p=0.005). The orthopedic disorder was more frequent in June than February (p=0.012). Infection was more frequent in February than June (p=0.011). The analyses in terms of meteoropathy, showed that the complaint of cough were more frequent after cold temperature in February (p=0.014). The gastrointestinal disorders were more frequent after humid (p=0.018) and pluvious days (p=0.016) in February. The complaint of headache was liable to be frequent after pluvious weather in June.<br>The relationship between weather and health is known in the prior an, and our study anew demonstrated the effect of season or meteorological phenomena, on chief complaints and disorders of outpatients, as statistical evidence.

Clinical Observations on Chief Complaints of Pediatric Patients

The following results were obtained from the clinicostatical observations on chief complaints of pediatric patients at National Medical Center in Seoul during the period from Jan. 1975 to Dec. 1979. 1. Total number of admission during the 5 year period were 3831 and male to female ratio was 1.73:1. 2. Annual incidence : a gradual increase was observed in number of admission. 3. Age incidence: the neonates and the infants less than 1year of age occupied 51.7% of total number of admission. 4. Seasonal incidence: the number of admission was significantly greater in autumn than in any other seasons in the age group above 4 weeks old age. 5. Frequency of chief complaints according to age was as following: i) In the early neonatal period, jaundice was the most frequent(40.7%) and low birth weight (22.2%), dyspnea(6.5%), vomiting(5.0%) etc. ii) In the age of 1 weeks, jaundice was the most frequent(26.0%) and poor sucking(9.5%), fever(8.1%_, cough(8.1%), skin lesion(7.7%) etc. iii) In the age of 4 weeks to 1 year, cough was the most frequent(18.9%) and diarrhea (14.4%), dyspnea(13.4%), fever(12.7%), vomiting(11.5%) etc. iv) In the age of 1 year to 2 years, fever was the most frequent(18.3%) and diarrhea (14.9%), vomiting(13.9%), cough(13.6%), dyspnea(9.9%) etc. v) In the age of 2 years, fever was the most frequent(18.7%) and cough(11.0%), dyspnea(8.5%), vomiting(6.4%), convulsion(6.0%) etc. vi) In the age of 6 years to 12 years, fever was the most frequent(18.7%) and cough(11.0%), dyspnea(8.5%), vomiting(6.4%), convulsion(6.0%) etc. vii) In the age of 12 years to 15 years, abdominal pain was themost frequent(10.3%) and fever(10.6%), dyspnea(9.0%), mental disturbance(8.4%), vomiting(7.5%) etc. 6. Frequency of chief complaints according to season: no significant variation was noted in each age groups, except that diarrhea was prominent in freauency in summer and autumn in the age of 4 weeks to 6 years. 7. The frequency of chief complaints all through the pediatric age is as following: fever(11.9%), cough(9.9%), dyspnea(9.3%), vomiting(8.6%), jaundice(8.1%), diarrhea(8.1%), convulsion(5.4%), low birth weight(3.9%), edema(3.3%), abdominal pain(2.9)\%), mental disturbance(2.8%), skin lesion(1.9%), etc