Background
Methods
Study design, setting, and ethical approval
Inclusion/exclusion
Data collection & extraction
Exposure: non-specific complaints
Primary and secondary outcomes
Justification of sample size
Statistical analysis
Results
Characteristics of patients with specific vs. non-specific complaints
Specific (n = 1310) | NSC (n = 190) | Total (n = 1500) | p | ||||
---|---|---|---|---|---|---|---|
Sociodemographic characteristics | |||||||
Age, [med (IQR)] | 50.0 | (33–67) | 55.5 | (39–68) | 51.0 | (34–67) | 0.027 |
Sex, [n (%)] | |||||||
Female | 640 | (48.9) | 73 | (38.4) | 713 | (47.5) | |
Male | 670 | (51.1) | 117 | (61.6) | 787 | (52.5) | 0.007 |
Swiss nationality, [n (%)] | 927 | (70.8) | 142 | (74.7) | 1069 | (71.3) | 0.258 |
Private insurance, [n (%)] | 171 | (13.1) | 40 | (21.1) | 1069 | (71.3) | 0.003 |
Transport by EMS | 373 | (28.5) | 46 | (24.2) | 419 | (27.9) | 0.221 |
Time and day of admission to ED | |||||||
Saturday or Sunday admission, [n (%)] | 431 | (32.9) | 51 | (26.8) | 482 | (32.1) | 0.095 |
Night-time admissions, [n (%)] | 593 | (45.3) | 74 | (38.9) | 667 | (44.5) | 0.101 |
Effective weekendsa, [n (%)] | 519 | (39.6) | 57 | (30.0) | 576 | (38.4) | 0.011 |
Effective days offb, [n (%)] | 443 | (33.8) | 53 | (27.9) | 496 | (33.1) | 0.105 |
Comorbidity | |||||||
COPD, [n (%)] | 75 | (5.7) | 9 | (4.7) | 84 | (5.6) | 0.580 |
Diabetes, [n (%)] | 153 | (11.7) | 38 | (20.0) | 191 | (12.7) | 0.001 |
Liver disease, [n (%)] | 89 | (6.8) | 16 | (8.4) | 105 | (7.0) | 0.411 |
Dementia, [n (%)] | 27 | (2.1) | 6 | (3.2) | 33 | (2.2) | 0.335 |
Past myocardial infarction, [n (%)] | 181 | (13.8) | 20 | (10.5) | 201 | (13.4) | 0.213 |
Malignancy, [n (%)] | 204 | (15.6) | 35 | (18.4) | 239 | (15.9) | 0.316 |
Peripheral artery disease, [n (%)] | 42 | (3.2) | 4 | (2.1) | 46 | (3.1) | 0.411 |
Chronic kidney disease, [n (%)] | 51 | (3.9) | 9 | (4.7) | 60 | (4.0) | 0.579 |
Cerebrovascular disease, [n (%)] | 98 | (7.5) | 16 | (8.4) | 114 | (7.6) | 0.648 |
Drug intake | |||||||
On any antidiabetic, [n (%)] | 104 | (7.9) | 27 | (14.2) | 131 | (8.7) | 0.004 |
On any antithrombotic, [n (%)] | 372 | (28.4) | 59 | (31.1) | 431 | (28.7) | 0.450 |
On any antihypertensive, [n (%)] | 411 | (31.4) | 69 | (36.3) | 480 | (32.0) | 0.172 |
On any diuretic, [n (%)] | 178 | (13.6) | 25 | (13.2) | 203 | (13.5) | 0.871 |
On any antibiotic, [n (%)] | 188 | (14.4) | 15 | (7.9) | 203 | (13.5) | 0.015 |
On any antiepileptic, [n (%)] | 108 | (8.2) | 14 | (7.4) | 122 | (8.1) | 0.680 |
On any opioids, [n (%)] | 97 | (7.4) | 15 | (7.9) | 112 | (7.5) | 0.810 |
On any psycholeptic, [n (%)] | 178 | (13.6) | 26 | (13.7) | 204 | (13.6) | 0.971 |
Consultation characteristic | |||||||
Triage category, [med (iqr)] | 3.0 | (2, 3) | 3.0 | (2, 3) | 3.0 | (2, 3) | < 0.001 |
Highly-urgent | 588 | (44.9) | 55 | (28.9) | 643 | (42.9) | |
Urgent | 722 | (55.1) | 135 | (71.1) | 857 | (57.1) | < 0.001 |
Resuscitation bay, [n (%)] | 17 | (1.3) | 2 | (1.1) | 19 | (1.3) | 0.778 |
Outcomes | |||||||
Hospitalisation, [n (%)] | 516 | (39.4) | 72 | (37.9) | 588 | (39.2) | 0.693 |
30 d revisits, [n (%)] | 175 | (13.4) | 22 | (11.6) | 197 | (13.1) | 0.497 |
365 d revisits, [n (%)] | 476 | (36.3) | 73 | (38.4) | 549 | (36.6) | 0.577 |
LOS hospital days, [med (iqr)] | 0.3 | (0.2–3.4) | 0.3 | (0.2–3.3) | 0.3 | (0.2–3.4) | 0.940 |
LOS ED hours, [med (iqr)] | 4.7 | (3.4–6.5) | 4.9 | (3.3–6.8) | 4.7 | (3.3–6.6) | 0.871 |
ICU admission, [n (%)] | 108 | (8.2) | 13 | (6.8) | 121 | (8.1) | 0.507 |
In-hospital death, [n (%)] | 21 | (1.6) | 5 | (2.6) | 26 | (1.7) | 0.310 |
OR | 95% CI | p | |
---|---|---|---|
Sociodemographic characteristics | |||
Age, per year | 1.01 | (1.00–1.02) | 0.040 |
Sex | |||
Female | 1.00 | (base) | |
Male | 1.53 | (1.12–2.09) | 0.007 |
Swiss nationality | 1.22 | (0.86–1.73) | 0.259 |
Private insurance | 1.78 | (1.21–2.61) | 0.003 |
Transport by EMS | 0.80 | (0.56–1.14) | 0.221 |
Time and day of admission to ED | |||
Saturday or Sunday | 0.75 | (0.53–1.05) | 0.096 |
Night-time admission | 0.77 | (0.57–1.05) | 0.102 |
Effective weekendsa | 0.65 | (0.47–0.91) | 0.011 |
Effective days offb | 0.76 | (0.54–1.06) | 0.106 |
Comorbidity | |||
COPD | 0.69 | (0.33–1.44) | 0.326 |
Diabetes | 2.07 | (1.36–3.15) | 0.001 |
Dementia | 1.56 | (0.61–3.95) | 0.352 |
Past myocardial infarction | 0.67 | (0.40–1.11) | 0.121 |
Malignancy | 1.14 | (0.76–1.72) | 0.521 |
Peripheral artery disease | 0.55 | (0.19–1.62) | 0.279 |
Chronic kidney disease | 1.16 | (0.54–2.46) | 0.708 |
Cerebrovascular disease | 1.14 | (0.64–2.02) | 0.655 |
Drug intake | |||
On any antidiabetic | 1.94 | (1.20–3.13) | 0.007 |
On any antithrombotic | 1.02 | (0.69–1.53) | 0.905 |
On any antihypertensive | 1.19 | (0.80–1.78) | 0.397 |
On any diuretic | 0.81 | (0.49–1.33) | 0.400 |
On any opioids | 0.84 | (0.46–1.53) | 0.561 |
On any antiepileptic | 1.04 | (0.58–1.88) | 0.893 |
On any psycholeptic | 1.01 | (0.64–1.59) | 0.981 |
Consultation characteristic | |||
Triage category | |||
Urgent | 1.00 | (base) | |
Highly-urgent | 0.50 | (0.36–0.70) | < 0.001 |
Outcomes | |||
Hospitalisation | 0.94 | (0.69–1.28) | 0.693 |
30 days revisits | 0.85 | (0.53–1.36) | 0.498 |
365 days revisits | 1.09 | (0.80–1.50) | 0.577 |
LOS hospital days | 1.01 | (0.99–1.03) | 0.564 |
LOS ED hours | 0.99 | (0.95–1.04) | 0.777 |
ICU admission | 0.82 | (0.45–1.48) | 0.508 |
In-hospital death | 1.66 | (0.62–4.45) | 0.315 |
Utilisation of diagnostic resources
GMR | 95% CI | p | |
---|---|---|---|
Sociodemographic characteristics | |||
Age, per year | 1.01 | (1.01–1.01) | < 0.001 |
Sex, male | 1.04 | (0.98–1.11) | 0.205 |
Swiss nationality | 1.14 | (1.07–1.23) | < 0.001 |
Private insurance | 1.17 | (1.07–1.28) | 0.001 |
Transport by EMS | 1.34 | (1.25–1.43) | < 0.001 |
Time and day of admission to ED | |||
Saturday or Sunday admission | 0.97 | (0.91–1.04) | 0.395 |
Night-time admissions | 0.78 | (0.74–0.83) | < 0.001 |
Effective weekendsa | 0.93 | (0.87–0.99) | 0.023 |
Effective days offb | 0.98 | (0.92–1.05) | 0.580 |
Comorbidity | |||
COPD | 1.17 | (1.02–1.34) | 0.026 |
Diabetes | 1.14 | (1.04–1.25) | 0.006 |
Liver disease | 1.16 | (1.03–1.31) | 0.015 |
Dementia | 1.51 | (1.22–1.87) | < 0.001 |
Past myocardial infarction | 1.18 | (1.07–1.29) | < 0.001 |
Malignancy | 1.33 | (1.22–1.44) | < 0.001 |
Peripheral artery disease | 1.18 | (0.99–1.42) | 0.068 |
Chronic kidney disease | 1.21 | (1.03–1.41) | 0.021 |
Cerebrovascular disease | 1.38 | (1.23–1.55) | < 0.001 |
Drug intake | |||
On any antidiabetic | 1.18 | (1.06–1.32) | 0.003 |
On any antithrombotic | 1.35 | (1.27–1.45) | < 0.001 |
On any antihypertensive | 1.31 | (1.22–1.4) | < 0.001 |
On any diuretic | 1.33 | (1.22–1.46) | < 0.001 |
On any antiepileptic | 1.04 | (0.93–1.17) | 0.497 |
On any psycholeptic | 1.15 | (1.02–1.29) | 0.025 |
Consultation characteristic | |||
Triage | |||
Urgent | 1 | (base) | |
Highly-urgent | 1.31 | (1. 22–1.39) | < 0.001 |
Outcomes | |||
Hospitalisation | 1.58 | (1.48–1.67) | < 0.001 |
30 d revisits | 0.97 | (0.88–1.06) | 0.474 |
365 d revisits | 1.01 | (0.95–1.08) | 0.752 |
LOS hospital days | 1.02 | (1.01–1.02) | < 0.001 |
LOS ED hours | 1.1 | (1.09–1.11) | < 0.001 |
ICU admission | 1.55 | (1.39–1.74) | < 0.001 |
In-hospital death | 1.46 | (1.15–1.85) | 0.002 |
ED diagnostic resource utilisation | GMR | 95% CI | p |
---|---|---|---|
NSC | 0.91 | (0.83–1.00) | 0.040 |
Age, per year | 1.01 | (1.01–1.01) | < 0.001 |
Private insurance | 1.06 | (0.97–1.15) | 0.197 |
On any antidiabetic | 1.07 | (0.97–1.19) | 0.189 |
Night admission | 0.83 | (0.78–0.88) | < 0.001 |
Effective weekends | 0.95 | (0.89–1.00) | 0.070 |
Triage | |||
Urgent (base) | 1.00 | ||
Highly-urgent | 1.25 | (1.17–1.32) | < 0.001 |