Derivation and validation of a chief complaint shortlist for unscheduled acute and emergency care in Uganda

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Abstract

Objectives

Derive and validate a shortlist of chief complaints to describe unscheduled acute and emergency care in Uganda.

Setting

A single, private, not-for profit hospital in rural, southwestern Uganda.

Participants

From 2009 to 2015, 26 996 patient visits produced 42 566 total chief complaints for the derivation dataset, and from 2015 to 2017, 10 068 visits produced 20 165 total chief complaints for the validation dataset.

Methods

A retrospective review of an emergency centre quality assurance database was performed. Data were abstracted, cleaned and refined using language processing in Stata to produce a longlist of chief complaints, which was collapsed via a consensus process to produce a shortlist and turned into a web-based tool. This tool was used by two local Ugandan emergency care practitioners to categorise complaints from a second longlist produced from a separate validation dataset from the same study site. Their agreement on grouping was analysed using Cohen’s kappa to determine inter-rater reliability. The chief complaints describing 80% of patient visits from automated and consensus shortlists were combined to form a candidate chief complaint shortlist.

Results

Automated data cleaning and refining recognised 95.8% of all complaints and produced a longlist of 555 chief complaints. The consensus process yielded a shortlist of 83 grouped chief complaints. The second validation dataset was reduced in Stata to a longlist of 451 complaints. Using the shortlist tool to categorise complaints produced 71.5% agreement, yielding a kappa of 0.70 showing substantial inter-rater reliability. Only one complaint did not fit into the shortlist and required a free-text amendment. The two shortlists were identical for the most common 14 complaints and combined to form a candidate list of 24 complaints that could characterise over 80% of all emergency centre chief complaints.

Conclusions

Shortlists of chief complaints can be generated to improve standardisation of data entry, facilitate research efforts and be employed for paper chart usage.

Related collections

Most cited references 15

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The National Capitol Region’s Emergency Department Syndromic Surveillance System:  Do Chief Complaint and Discharge Diagnosis Yield Different Results?

Elizabeth Begier, Denise Sockwell, Leslie Branch … (2003)

We compared syndromic categorization of chief complaint and discharge diagnosis for 3,919 emergency department visits to two hospitals in the U.S. National Capitol Region. Agreement between chief complaint and discharge diagnosis was good overall (kappa=0.639), but neurologic and sepsis syndromes had markedly lower agreement than other syndromes (kappa statistics 0.085 and 0.105, respectively).

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Making recording and analysis of chief complaint a priority for global emergency care research in low-income countries.

Hani Mowafi, Daniel A. Dworkis, Mark Bisanzo … (2013)

The chief complaint is a patient's self-reported primary reason for presenting for medical care. The clinical utility and analytical importance of recording chief complaints have been widely accepted in highly developed emergency care systems, but this practice is far from universal in global emergency care, especially in limited-resource areas. It is precisely in these settings, however, that the use of chief complaints may have particular benefit. Chief complaints may be used to quantify, analyze, and plan for emergency care and provide valuable information on acute care needs where there are crucial data gaps. Globally, much work has been done to establish local practices around chief complaint collection and use, but no standards have been established and little work has been done to identify minimum effective sets of chief complaints that may be used in limited-resource settings. As part of the Academic Emergency Medicine consensus conference, "Global Health and Emergency Care: A Research Agenda," the breakout group on data management identified the lack of research on emergency chief complaints globally-especially in low-income countries where the highest proportion of the world's population resides-as a major gap in global emergency care research. This article reviews global research on emergency chief complaints in high-income countries with developed emergency care systems and sets forth an agenda for future research on chief complaints in limited-resource settings.

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A Comparison of the Kampala Trauma Score (KTS) with the Revised Trauma Score (RTS), Injury Severity Score (ISS) and the TRISS Method in a Ugandan Trauma Registry

Jana B. A. MacLeod, Olive Kobusingye, Chris Frost … (2003)

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Open

Journal ID (iso-abbrev): BMJ Open

Journal ID (hwp): bmjopen

Journal ID (publisher-id): bmjopen

Title: BMJ Open

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2044-6055

Publication date Collection: 2018

Publication date (Electronic): 27 June 2018

Volume: 8

Issue: 6

Electronic Location Identifier: e020188

Affiliations

[1 ] departmentEmergency Medicine , New York University Langone Medical Center , New York City, New York, USA

[2 ] departmentEmergency Medicine , Stanford University School of Medicine , Stanford, California, USA

[3 ] departmentDivision of Emergency Medicine, Department of Surgery , University of Vermont , Burlington, Vermont, USA

[4 ] departmentPsychiatry , Mbarara University of Science and Technology , Mbarara, Uganda

[5 ] departmentEmergency Medicine , Texas A&M , Corpus Christi, Texas, USA

[6 ] departmentEmergency Medicine , Yale University , New Haven, Connecticut, USA

Author notes

[Correspondence to ] Dr Brian Travis Rice; brice@ 123456stanford.edu

Author information

Brian Travis Rice http://orcid.org/0000-0002-9093-1831

Article

Publisher ID: bmjopen-2017-020188

DOI: 10.1136/bmjopen-2017-020188

PMC ID: 6020949

PubMed ID: 29950461

SO-VID: c7b51bed-5969-40d4-8272-528bfd84b07a

License:

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

History

Date received : 24 October 2017

Date revision received : 16 April 2018

Date accepted : 22 May 2018

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ScienceOpen disciplines: Medicine

Keywords: epidemiology,public health

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ScienceOpen disciplines: Medicine

Keywords: epidemiology, public health

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