Nonspecific complaints in emergency medicine: contribution of clinical chemistry and diagnostic imaging to final diagnosis. An observational study

Objective: To determine the contribution of history, physical examination, clinical chemistry, and diagnostic imaging to the validated final diagnosis in patients presenting with nonspecific complaints to the emergency department (ED). Methods: This is a secondary analysis of Basel Non-specific Complaints (BANC), a multicentre prospective observational study. A final diagnosis was validated for every patient after a 30 days follow-up. A team of experts rated the contribution of the emergency work-up, and of clinical chemistry, diagnostic imaging, specialist consultation, and other exams to the final diagnosis. Results: 612 non-trauma patients with NSC were prospectively included. After exclusion of 19 patients due to protocol violation or missing information, 593 patients were analysed. 412/593 (69%) validated final diagnoses were attributed to the ED work-up, and 181 (31%) to subsequent work-up by internal medicine, geriatrics, or outpatient clinics. Clinical chemistry was judged to be decisive for 300/593 (51%), and imaging for 106/593 (18%) of all final diagnoses. Chest radiography was decisive in 50 (8%), cranial computed tomography or magnetic resonance imaging in 21 (4%), and chest computed tomography in 10 (2%) cases. Conclusion: Clinical chemistry and imaging contribute substantially to the diagnoses of patients presenting to the ED with NSC. However, post-ED-workup including consultations by specialists (e.g., neurology, geriatrics, psychiatry) were decisive for almost a third of all final diagnoses.