Table 2 Mismatches identified and resulting recommendations
From: Calibrating a chief complaint list for low resource settings: a methodologic case study
Chief complaint (n) | Discussion | Recommendation |
|---|---|---|
Abdominal pain (22) | Only pain checked; provider did not keep searching for proper CC | Remove pain |
Abnormal blood pressure (1) | Only pain checked; provider did not keep searching for proper CC | Change to high blood pressure |
Abnormal glucose (2) | Only pain checked; provider did not keep searching for proper CC | Remove pain |
Abscess (5) | Pain checked/too general, can be captured in rash/skin problem | Remove abscess |
Alcohol/drug problem (2) | Medication issue checked instead of alcohol | Change to poisoning/alcohol/drug problem |
Blood in cough/nose (1) | Hemoptysis and epistaxis are separate entities | Change to coughing/vomiting blood, as epistaxis can be captured by ear/nose/mouth |
Bloody D/V (4) | Bloody diarrhea deserves its own category to capture dysentery cases; move bloody vomiting to coughing/vomiting blood | Change to bloody diarrhea to capture dysentery |
Chest pain (11) | Pain checked; provider did not keep searching for proper CC | Remove pain |
Confusion/AMS (1) | AMS is not lay terminology | Change to confusion |
Decreased urine output (1) | Pain checked; provider did not keep searching for proper CC | Remove pain |
Diarrhea/constipation (2) | Pain checked; provider did not keep searching for proper CC | Remove pain |
ENT (12) | ENT is not lay terminology; also, likely unknown term outside of Western medicine | Change to ear/nose/mouth |
Eye problem (2) | Issues unrelated to eye problem | Remove abscess |
Focal weak/numb (2) | Issues unrelated to focal weak/numb, however can capture stroke-like symptoms in one broad category Limb weakness/facial droop | Change to limb weakness/facial droop |
Fracture/deformity (2) | Pain checked; provider did not keep searching for proper CC | No change recommended |
Generalized weakness (2) | Pain checked; provider did not keep searching for proper CC | Remove pain |
GU complaint (15) | GU is not lay terminology; maybe out of cultural context. Often checked for rectal complaints | Remove GU complaint, add urinary problem, penis/vagina problem or genital problem, and rectal problem |
Headache (3) | Occasionally checked in context of traumatic injury | No change recommended |
Mass (1) | Not very specific | Change to suspected cancer/mass |
Nausea/vomiting (3) | Pain checked; provider did not keep searching for proper CC | Remove pain |
Pain (3) | Only three instances where Pain could have better described the intended CC; thousands of instances where pain was checked when another CC could provide more useful data | Remove pain |
Pregnancy complication (1) | Complication not lay terminology | Change pregnancy complication to pregnancy problem |
Psychiatric illness/SI (1) | Was not checked when it should have been | No change recommended |
Rash/skin lesion (4) | Lesion not lay terminology | Change to rash/skin problem |
Seizure/convulsion (4) | Convulsion not lay terminology | Change to fits/seizure |
Shortness of breath (5) | May be out of cultural context | Change to breathing problem |
Speech problem (1) | Was not checked when it should have been | No change recommended |
Swelling (2) | Unclear whether refers to generalized edema or focal swelling | No change recommended; will place under limb/swelling heading to discourage use for skin complaints |
Syncope/fainting (2) | Syncope not lay terminology | Change syncope/fainting to fainting/dizziness |
Vaginal bleeding (2) | Issues unrelated to vaginal bleeding | No change recommended |
Generalized weakness | Was not ticked in cases of fatigue or just weakness, thus modified to be more inclusive | Change to generalized weakness/fatigue |
GU complaint involved in several mismatches | GU is not lay terminology and was frequently used inappropriately for rectal complaints; likely unknown term outside of Western medicine. Difficult to find a ubiquitous term for these complaints | Change to genital problem |
Mass represented < 0.5% of visits | It seems as if trying to capture concern for cancer, but was often not ticked because not explicit enough | Change to suspected cancer/mass |
Medication issue represented < 0.5% of visits | Unsure what this is trying to capture | Combine with poisoning/ingestion/medication problem |
Wound | Not specific enough and staff did not understand | Change to wound from injury |