Non-specific complaints in patients admitted to emergency departments

Abstract

Background: To define non-specific complaints (NSCs) and discuss their relevance in the emergency department (ED), particularly focusing on elderly patients. Methods: We conducted a retrospective, multicenter study in eight tertiary care hospitals’ EDs to assess the distribution and clinical outcomes of NSCs and specific complaints (SCs) among adults. The study included 192,426 adults over 18 years old, including 42,554 individuals aged 65 years and older, who visited the EDs. The primary outcome was the distribution of NSCs and SCs across the two age groups (<65 years vs. ≥65 years). Univariable statistics compared the distribution and clinical outcomes between these age groups. Results: Young adults showed a 10% incidence of NSC (14,971 out of 148,872), while those aged ≥65 years had an 18% incidence (7667 out of 42,554). NSC patients had a longer ED length of stay (LOS) (younger: 145.0 ± 65.2 vs. 127.5 ± 70.1 minutes, p < 0.001; older: 183.0 ± 78.7 vs. 171.3 ± 87.2 minutes, p < 0.001). Hospital admission rates were higher among SC patients (younger: 14.9% vs. 11.1%, p < 0.001; older: 36.7% vs. 24.8%, p < 0.001), as were hospital LOS (younger: 4.8 ± 10.5 vs. 4.7 ± 10.4 days, p < 0.001; older: 7.9 ± 14.0 vs. 6.3 ± 12.6 days, p < 0.001). Intensive care unit (ICU) admissions were higher for younger NSC patients (19.7% vs. 17.5%, p = 0.027), but lower for older NSC patients (26.0% vs.30.2%, p < 0.001). Conclusions: Elderly NSC patients show longer ED LOS, lower hospital admission rates, shorter hospital LOS, and lower ICU admission rates when, compared to SC patients. More research and standardized definitions are needed to optimize ED management for adults over 65 years. © 2025 Elsevier B.V., All rights reserved.