Functional Somatic Symptoms in Emergency Department Frequent Presenters

doi:10.21203/rs.3.rs-2371815/v1

Download PDF

Research Article

Functional Somatic Symptoms in Emergency Department Frequent Presenters

https://doi.org/10.21203/rs.3.rs-2371815/v1

This work is licensed under a CC BY 4.0 License

Journal Publication

published 18 Jul, 2024

Read the published version in BMC Emergency Medicine →

You are reading this latest preprint version

Background: Patients with Functional Somatic Symptoms (FSS) are frequently encountered within healthcare settings such as Emergency Departments (ED). There is limited research regarding characterisation and frequency of FSS within frequent presenters to ED and no previous Australian evidence. This study aims to fill this gap.

Methods: A retrospective, single-centre study of frequent ED presenters over a 6-month period was undertaken. Patients with >3 re-presentations/month were reviewed for the presence of FSS using Stephenson and Price’s ¹ categorisation of FSS. Patients were divided into three groups – FSS, possible FSS (pos-FSS) and non-FSS. The characteristics of these groups were compared using descriptive statistics (chi-square tests, ANOVA). Person-time at risk during the 6-month study period was estimated for patients in each group and incidence of ED presentation for each group was then calculated. Psychological distress indicators for ED presenters with FSS, as noted by the treating clinician, were also analysed.

Results: 11% (71/638) of frequent ED presenters were categorised as having FSS and 17% (109/638) as having possible FSS (pos-FSS). Mean ED presentations in the FSS group during the study period were significantly higher than in the non-FSS and pos-FSS groups (p<.01). Anxiety was found to be the primary psychological distress indicator associated with ED presentations with FSS.

Conclusion: We found that, amongst frequent ED presenters, patients with FSS presented significantly more frequently to ED than those without FSS. We propose revising the model of care for FSS in ED to promote appropriate referral to therapy services as a possible demand reduction strategy to improve patient care and efficiency in ED.

Functional Somatic Symptoms

Medically Unexplained Symptoms

frequent ED presenters. Psychological distress in ED

Somatization in ED

Somatization defined as “a tendency to experience and communicate psychologic distress in the form of physical symptoms and seek medical help” ² is ubiquitous within healthcare ³, ⁴, ⁵. These disorders are variously referred to as Functional Somatic Symptoms (FSS), Somatoform Disorder, or Medically Unexplained Symptoms (MUS). ⁶ Somatization disorders are common in the Emergency Department (ED) ¹ and present both in adult ⁷and paediatric ^{8, 9} populations. Somatization is associated with excess healthcare costs ¹⁰, iatrogenic harm and poor patient outcomes ¹¹.

Frequent presenters to EDs tend to be complex and resource-intensive. ^{12 13 14} Individuals with somatization comprise a significant proportion of frequent presenters to ED ^{7 15}. Prior research indicates that somatization is a significant contributor to health care costs in ED ¹⁰. This cost is particularly significant in recent times due to stretched healthcare resources compounded by the COVID-19 pandemic ^{16 17}. There is limited literature regarding the prevalence of somatization amongst ED presentations. Existing studies indicate various rates of FSS in frequent ED presentations ranging from 13.4% ⁷ to 28% ¹⁸. These studies differ in their definition of frequent presentations (> 2 visits in 2 years vs > 4 visits in six months)^{7 18} and their criteria for somatization. A recent UK study found an increase in ED presentations for medically unexplained symptoms despite an overall reduction in presentations during the COVID-19 pandemic ¹⁹. There is no known Australian published literature about the prevalence of FSS in frequent ED presenters and the current study seeks to address this gap.

The study aimed to estimate the characteristics and prevalence of FSS in frequent ED presenters and to identify burden of disease attributable to FSS. The objectives of this study were to determine the following:

1) Proportion of frequent ED presenters that could be identified as FSS, possible FSS (Pos-FSS), and non-FSS

2) Mean number of ED presentations for those categorised as FSS, Pos-FSS, and non-FSS

and

3) Differences in the characteristics of those categorised as FSS, Pos-FSS, and non-FSS.

The study was conducted at the Emergency Department (ED) of Townsville University Hospital (TUH), Queensland, Australia. TUH is the tertiary referral centre for North Queensland servicing a catchment of ~ 700,000 people²⁰. TUH had an annual ED census of 91,997 in 2020–2021. ²¹

Patient selection and data abstraction

This is a retrospective, single-centre study of patients who frequently presented to TUH ED between October 1st, 2016 - March 31st, 2017. Two investigators (VG1 and KT) independently determined patient eligibility for inclusion into FSS, Pos-FSS, or non-FSS groups. (Fig. 1), collated qualitative descriptions of stressors from patient charts and analysed data.

A consensus definition of frequent ED presenters is lacking although there have been attempts to operationalise the concept ²². For this study, we defined a frequent ED presenter as someone who presents 3 or more times in a calendar month to ED. This definition was used for operational convenience since the organisation where this study took place produces an administrative report each month identifying these individuals. The report is called the ED recidivist report (EDRR) and contains details relating to patient’s name, number of presentations, arrival date and time for each presentation, and discharge diagnosis. All the patients on the EDRR were stratified into one of the three groups (FSS, Pos FSS and non FSS, see Fig. 1) based on Stephenson and Prices’¹ description of FSS. Frequent presenters with FSS included presentations ranging across non-cardiac chest pain, benign palpitations, nonspecific abdominal pain, non‐ulcer dyspepsia, physical symptoms of anxiety and depression, nonspecific symptoms (e.g. “funny turns”), symptoms with undiagnosed organic pathophysiology, no obvious pathology and non-specific presenting issues. Patients with an equivocal clinical diagnosis, such as cases with one or more presentations with FSS but an established underlying pathology that could result in similar symptoms (e.g. non-cardiac chest pain in patients with established ischaemic heart disease), were classified as possible FSS (pos-FSS) group. The presentation for these patients may have been due to FSS, and these patients were included in the study to enrich our understanding. If none of the presentations for a patient met the criteria for FFS, the patient was categorised as non-FFS group. Patients were also classified as non-FFS if they had been diagnosed as having severe mental disorder (e.g., Bipolar disorder, major depression, psychotic episode or schizophrenia), suicidal ideation or known drug seeking behaviour. The classification of cases as FSS, Pos FSS or Non-FSS was carried out by two clinical psychologists (VG1 and KT).

Since there was no published Australian literature regarding operationalizing FSS amongst ED presentations at the time of study, previous EDRRs were used to familiarize the two psychologists regarding FSS using re-presentation reports and patient charts. This helped create shared understanding of FSS as described in the patient selection algorithm (Fig. 1). The psychologists undertook chart reviews of 144 frequent presenters identified through one of the earlier EDRRs to assess for inter-rater reliability. Presentations were independently rated as being FSS or Non-FSS and inter-rater reliability was calculated using Pearson's co-efficient of correlation (r = 0.9).

Data Analyses

The data were analysed using Statistical Packages for Social Science (SPSS) version 26 and Microsoft Excel 10. Descriptive statistics were used to describe frequent ED presentations among those characterised as FSS, pos-FSS and non-FSS. Means with standard deviations were used for continuous variables and counts with proportions were used for categorical variables. Differences between frequent presenters categorised as FSS, Pos-FSS and non-FSS were assessed using independent chi-square tests or ANOVA, as appropriate.

Person—time at risk of ED presentation during the study period was calculated for each frequent presenter, and then separately for those categorised as FSS, Pos-FSS and non-FSS. Subsequently, the incidence rate of ED presentation was calculated for the three groups (number of ED presentations/person- time at risk). Rates are presented per 100-person days. The relative risk of ED presentation (with 95%CI) was calculated for those categorised as FSS compared to non-FSS. Relative risks were also calculated for pos-FSS compared with non-FSS.

Qualitative data regarding psychological distress indicators for those included in the study as FSS were descriptively analysed. Psychological distress indicators were defined as indicators for psychological distress noted by the treating ED clinician in the patient’s chart. For example, “ the patient appeared highly anxious” or “patient reports a recent break up in relationship”. These were extracted directly from patient charts as recorded by the treating ED clinician (usually an ED nurse or a doctor). Researchers (VG1 and KT) then thematically grouped into the following categories: Anxious (Anxious mood and high anxiety); depressed, financial stress, living /residential stressor; psychosocial family/relationship issues; PTSD and psychosocial distress (including distressed and tearful). The last category was a category of exclusion when the distress indicator could not be classified in any other category. Categories were not mutually exclusive and patients could have more than one psychological distress.

Prevalence of FSS in Frequent ED Re-presenters

Of the 638 unique frequent ED presenters during the study period, 71 (11%) were categorised as having FSS, 109 (17%) as Pos-FSS, and 458 (72%) as Non-FSS (Fig. 1).

Age distribution

Sample characteristics by FSS category are shown in Table 1 and Fig. 2. Those aged 50-59-years accounted for the highest proportion of frequent presenters categorised as FSS (Fig. 2) followed by those 20 to 29 and 30–39 years. There is also a peak of FSS frequent presenters relative to Pos FSS, between the ages of 70–79 years (Fig. 2).

Table 1

Comparison between FSS subgroups -Patient Characteristics
Patient Characteristics	FSS (n = 71)	Non FSS (n = 458)	Pos-FSS (n = 109)	Total N = 638
Gender Male Female	30 (42.3%) 41 (57.7%)	232 (50.7%) 226 (42.3%)	50 (45.9%) 59 (54.1%)	312 (48.9%) 326 (51.1%)
Ethnicity** Aboriginal / Torres Strait / South Sea Islander All other	7 (9.9%) 64 (90.1%)	140 (30.6%) 317 (69.4%)	31 (28.4%) 78 (71.6%)	178 (27.9%) 459 (72.1%)
*. The mean difference is significant at the 0.05 level
**. The mean difference is significant at the 0.01 level

Gender and ethnicity

There was no association between patient sex and the presence of FSS (X² = 2.22 df 2 p = .33) (p > 0.05); (Table 1). FSS categorization varied by ethnicity (Table 1) (X² = 13.19; df = 2; p < .01). Despite constituting 27.9% of frequent presenters, persons identifying as Aboriginal/Torres Strait /South Sea Islander accounted for only 9.9% of FSS presentations, compared with 30.6% of Non FSS and 28.4% of pos-FSS (Table 1).

FSS amongst frequent ED presenters

Table 2 shows the frequency of presentation for patients categorised as FSS, Pos-FSS and non-FSS. Mean ED presentations during the 6-month study period (Table 2) were significantly higher among frequent ED presenters categorised as FSS (X = 6.35 presentations; SD = ± 6.007) than either Pos-FSS (4.81 presentations; SD = ± 2.936 ) or non-FSS (4.05 presentations; SD = ± 1.823) (F = 23.64; df = 2; p < .001). Additionally, ED presentations were higher among frequent presenters categorised as pos-FSS compared with non-FSS (p < 0.05).

Table 2

Comparison between FSS subgroups – Mean ED presentations
Groups	FSS	Pos FSS	Non FSS
N	71	109	399
Mean	6.35	4.81	4.05
SD	6.007	2.936	1.823
Min presentations	3	3	3
Max presentations	38	26	26
Mean difference compared to FSS	n/a	-1.545**	2.302**
*. The mean difference is significant at the 0.05 level
**. The mean difference is significant at the 0.01 level
NB. Overall percentages do not add to 100 because some individuals had more than one psychological distress indicator listed in their charts.

Contributions of FSS categories to burden in ED re-presentations

To assess the proportionate extent of the impact of FSS on the number of frequent re-presentations, we compared the total ED presentations for each FSS category (Fig. 3). The 638 frequent presenters yielded a total of 2808 ED presentations during the 6-month study period. The 11% of frequent ED presenters who were categorised as FSS accounted for 16% of the total ED presentations made by frequent presenters. Comparatively, the 17% of frequent ED presenters who were categorised as Pos-FSS accounted for 19% of total presentations made by frequent presenters (Fig. 3).

The incidence of ED presentations was calculated for each group. Among frequent presenters categorized as FSS, the incidence of ED presentations during the study period was 4.18 per 100 person days (95%CI: 3.76–4.61). This was 1.29 times higher (95% CI: 1.16–1.43) than frequent presenters categorized as non-FSS (IR: 2.04 per 100 person-days; 95%CI:2.93–3.57), and 1.47 times higher (95% CI: : 1.32–1.63) than frequent presenters categorized as Pos-FSS (IR: 2.85 per 100 person days; 95%CI: 2.71–2.99). The proportion of ED presentations among those categorized as FSS attributable to FSS was 30.14% (Attributable Fraction). Among this group of frequent presenters(FSS, pos FSS, and non-FSS), 4.6% of all ED presentations during the study period were attributable to FSS (population attributable fraction)

Psychological Distress amongst ED Frequent presenters with FSS

Anxiety was the main psychological distress indicator associated with frequent ED presentation for FSS (64.7%; Fig. 4). Other indicators included psycho-social, family and relationship stressors (25.3%), depression (18%) and stressors associated with place of residence (~ 10%).

Despite the ubiquitousness of FSS in healthcare systems, there is limited research regarding the frequent ED presenters with FSS in Australian EDs. We analysed frequent ED presenters (> 3 ED presentations/month) for FSS over 6 months and found that 11% of frequent ED presenters presented for FSS, accounting for a disproportionately large number of ED presentations (16%). We further found that individuals with FSS presented more frequently than individuals with either possible FSS (Pos-FSS) or those without FSS (non-FSS).

Our findings suggest that individuals with FSS have higher utilisation of healthcare services including a higher incidence of ED visits than those without FSS. This finding is broadly consistent with existing literature.^{7 18 10} We have found lower proportion of FSS in our study compared to the studies of Alsma et al. ⁷ and Theadom et al. ¹⁸. This is likely due to different eligibility criteria for study inclusion. Alsma et al. ⁷ included all ED patient presentations and Theadom et al. ¹⁸ included ED patients with > 4 presentations over 6 months. We included only ED patients with ≥ 3 presentations in a calendar month. By our definition those patients who would have presented to ED twice in every calendar month during our study period would therefore not have been included as FSS in our sample, whilst they would have been included in the other studies.

Secondly, our results could also be attributed to the stringency of our selection criteria. Alsma et al. ⁷ included patients with “symptoms without an adequate explanation despite adequate assessment of history and physical examination, diagnostic testing in the ED or during follow-up” In contrast we used Stephenson and Price¹ categories to define patients with FSS. Additionally, our inclusion criteria required agreement for inclusion by two clinical psychologists and study team members unlike Theadom et al ¹⁸ who used a single researcher (a clinical psychologist) for categorisation. Furthermore, Theadom et al ¹⁸ used a binary approach to categorisation where individuals with symptoms not attributable to an organic cause were categorised as FSS or no FSS. This would likely have led to the categorisation of patients with medically unexplainable chest pains and a history of previous heart attack as FSS whilst our study would have categorized such patients as possible FSS (Pos-FSS). Our study also applied a rigorous diagnostic algorithm and a separate category of Pos-FSS for similar conditions. Interestingly, if we included all FSS and Pos FSS cases in a single category, the combined category would comprise 28% of all frequent ED presenters in our study, which is identical to the proportion of FSS observed by Theadom et al. ¹⁸ We also identified a similar proportion (57.7% vs 57.6%) of female patients amongst frequent ED presenters with FSS as Alsma et al. ⁷

Anxiety was the leading concomitant psychological distress indicator in our study, as with Theadom et al’s ¹⁸ study. Alsma et al. ⁷ et al found depression and panic disorder in almost a third of their sample and anxiety disorder in a fifth of their sample. Our findings could have implications for both the aetiology of FSS amongst ED presentations and for service redesign to meet current clinical needs. The standard treatment offered for FSS in ED settings involves advising regarding positive health behaviours and reassuring such patients regarding their health, encouraging them to contact their GP and return to the ED if symptoms persist. Since anxiety appears to be the most pressing concomitant psychological concern, it is likely that any reassurance that is offered in ED regarding the apparent absence of a physical disorder will have only a temporary effect. This presence of high anxiety is likely to result in individuals repeatedly presenting either to seek reassurance or as a response to resurgence in anxiety over time. An effective framework for reducing the risk of re-presentation is therefore likely to require improved anxiety management and provision of comprehensive care, rather than further investigations, in keeping with treatment guidelines ^{6 4}.

Implications

The most important clinical implication of our study is to guide the provision of high-value care in ED. In keeping with earlier researchers in the field ^{7 6, 18 4} we concur that early identification of patients experiencing FSS could lead to different and potentially more appropriate treatment. This will likely improve the quality of care that these patients receive in addition to patient experience and outcomes. It may potentially also have beneficial impacts upon ED workload ⁷ by reducing ED presentations and reducing overall health service utilisation and costs. This is particularly relevant given the emerging literature identifying an increase in FSS presentations to EDs after the commencement of the COVID-19 pandemic. ²³

Our findings suggest that frequent ED presenters with FSS contribute a disproportionately high number of service-episodes and are at an increased risk of re-presentation. We therefore suggest that individuals who frequently re-present to ED should be screened for FSS and referred to appropriate services.

There are no Australian data regarding the overall cost of somatization amongst ED presentations, although international literature indicates that it could be very high ^{10 24}. It would be of particular interest to identify the real-world direct and indirect costs of somatization to assess the feasibility and potential economic benefit of creating alternate clinical pathways and service redesign.

Limitations

These are preliminary findings of a single-centre study over a limited time with inherent limited generalizability. There is a need to replicate our findings across additional centres to develop a more comprehensive understanding of FSS and its identification. This will assist in effectively identifying patients and the true extent of the problem. Further, our study used very stringent criteria for FSS. Had we applied less strict criteria then we might have found a higher prevalence in keeping with previous research.

Our sampling only included individuals who presented three or more times in any calendar month and thus likely underestimates the true extent of FSS and FSS episodes in ED – both cross-sectionally (< 3 episodes/month not counted) and longitudinally (any FSS presentation after or before 6 months not counted). A strength of the study is that there is only one public hospital in the area, and so the sample is representative of those who regularly seek urgent medical attention in the region.

As a preliminary study, ours was designed to assess the burden of frequent ED presentations conferred by patients with FSS with our findings suggesting that further research is warranted. Future areas for more detailed exploration include identifying the actual burden conferred by such patients in ED settings (time spent in ED, procedures and tests performed, etc), across different clinical settings (e.g., prehospital, primary healthcare), and what strategies might successfully divert their presentations to appropriate services.

We found that 11% of frequent ED presenters were categorised as FSS, contributing to 16% of ED presentations over a six-month period. The mean number of ED presentations for those identified to have FSS was significantly higher than for other patients. Among the frequent presenters, the presence of FSS increased the risk of presentations to ED. Anxiety was the most frequent psychological distress indicator and was present in two-thirds of those presenting with FSS to ED. Appropriate and early identification and treatment for patients with FSS presenting to EDs could provide more appropriate patient care and, over a period, potentially serve to reduce ED presentations. These findings have significant implications for delivering high-value emergency clinical care in the post-COVID era.

Competing interests

There are no competing interests.

Consent of Publication

N/A

Authors' contributions

VG1 conceived this work, and its design, VG1 and KT were involved in data collection and preliminary analysis; KT MP and KW were involved in data cleaning and further data analysis; VG1 was involved in interpretation critical analysis and visual presentation of the data, as well as drafting; VG2, AJM; JG and KW were involved in critical review of the findings. All authors revised the work critically for important intellectual content and provided the final approval for the version to be published as well as the agreement to be accountable for all aspects of the work.

Acknowledgements

The authors would like to acknowledge the support from Amanda Trezona and Bede Ashley, Allied Health Team Leaders ED and Tilley Pain, research fellow allied health and the Research Education Support and Administration Unit at Townsville University Hospital.

Ethics approval and consent to participate statement

Ethical approval for this research was provided by the Townsville Hospital and Health Service Human Research Ethics Committee (HREC/16/QTHS/64). All research was carried out in accordance with relevant guidelines and regulations. The Human Research Ethics Committee approved the study protocol with the waiver for Informed consent under the NHMRC National Ethics Statement and local Hospital and Health Boards Act 2011 (Queensland; Section 150) in line with approving this project prospectively as a Quality Assurance and Audit Project

Data availability statements:

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request

Funding

This study was funded by a Research Grant from the Townsville Hospital and Health Service Study Education and Research Trust Account (SERTA).

Stephenson DT, Price JR. Medically unexplained physical symptoms in emergency medicine. Emerg Med J. 2006;23(8):595.
Lipowski ZJ. Somatization: a borderland between medicine and psychiatry. CMAJ: Canadian Medical Association journal = journal de l'Association medicale canadienne. 1986;135(6):609–14. PubMed PMID: 3489512.
de Waal MW, Arnold IA, Eekhof JA, van Hemert AM. Somatoform disorders in general practice: prevalence, functional impairment and comorbidity with anxiety and depressive disorders. Br J Psychiatry. 2004 Jun;184:470–6. PubMed PMID: 15172939. Epub 2004/06/03. eng.
Roenneberg C, Sattel H, Schaefert R, Henningsen P, Hausteiner-Wiehle C. Functional Somatic Symptoms. Deutsches Aerzteblatt International. 2019;116(33/34):553 – 60. PubMed PMID: 138763284. Language: English. Entry Date: In Process. Revision Date: 20200803. Publication Type: Article. Journal Subset: Biomedical.
Nimnuan C, Hotopf M, Wessely S. Medically unexplained symptoms: an epidemiological study in seven specialities.J Psychosom Res. 2001Jul;51(1):361–7. PubMed PMID: 11448704. Epub 2001/07/13. eng.
Mayou R, Farmer A. ABC of psychological medicine: Functional somatic symptoms and syndromes. Bmj. 2002 Aug 3;325(7358):265-8. PubMed PMID: 12153926. Pubmed Central PMCID: PMC1123778. Epub 2002/08/03. eng.
Alsma J, Wouw Jvd, Jellema K, Coffeng SM, Tobback E, Delesie L et al. Medically unexplained physical symptoms in patients visiting the emergency department: an international multicentre retrospective study.European Journal of Emergency Medicine. 2019;26(4).
Cozzi G, Barbi E. Facing somatic symptom disorder in the emergency department.Journal of Paediatrics and Child Health. 2019 2019/01/01;55(1):7–9.
Virk P, Vo DX, Ellis J, Doan Q. Pediatric somatization in the emergency department: assessing missed opportunities for early management. CJEM. 2020;22(3):331–7. Epub 2020/02/10.
Barsky AJ, Orav EJ, Bates DW. Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Arch Gen Psychiatry. 2005 Aug;62(8):903–10. PubMed PMID: 16061768. Epub 2005/08/03. eng.
Webster R, Norman P, Goodacre S, Thompson A. The prevalence and correlates of psychological outcomes in patients with acute non-cardiac chest pain: a systematic review. Emerg Med J. 2012 Apr;29(4):267–73. PubMed PMID: 22034535. Epub 2011/10/29. eng.
Eslick GD, Talley NJ. Non-cardiac chest pain: squeezing the life out of the Australian healthcare system? Med J Aust. 2000 Sep;173(5):233–4. PubMed PMID: 11130345. eng.
Duseja R, Bardach NS, Lin GA, Yazdany J, Dean ML, Clay TH, et al. Revisit Rates and Associated Costs After an Emergency Department Encounter. Ann Intern Med. 2015;162(11):750–6. 2015/06/02.
Markham D, Graudins A. Characteristics of frequent emergency department presenters to an Australian emergency medicine network. BMC Emerg Med. 2011;2011/12/16(1):21.
Ravindranath D. Somatic symptom and related disorders in the emergency department. Behavioral emergencies for healthcare providers, 2nd ed. 2021:107 – 13. English.
Kaye AD, Okeagu CN, Pham AD, Silva RA, Hurley JJ, Arron BL et al. Economic impact of COVID-19 pandemic on healthcare facilities and systems: International perspectives. Best Practice & Research Clinical Anaesthesiology. 2021 2021/10/01/;35(3):293–306.
Health, AIo. Welfare. Health expenditure Australia 2019-20. Canberra: AIHW; 2021.
Theadom A, Dupont S, Byron K. Functional somatic symptoms in accident and emergency – An exploratory study.Accident and Emergency Nursing. 2006 2006/07/01/;14(3):171–7.
Daniels NF, Ridwan R, Barnard EBG, Amanullah TM, Hayhurst C. A comparison of emergency department presentations for medically unexplained symptoms in frequent attenders during COVID-19. Clin Med. 2021;21(4):e399.
Queensland Government. Emergency Departments | Townsville Hospital and Health Service. 2022.
Welfare AIoHa, Emergency Department Care AIHW. ; 2022 [updated 14/07/2022; cited 2022 28 November 2022]. Available from: https://www.aihw.gov.au/reports-data/myhospitals/sectors/emergency-department-care.
Doupe MB, Palatnick W, Day S, Chateau D, Soodeen R-A, Burchill C et al. Frequent Users of Emergency Departments: Developing Standard Definitions and Defining Prominent Risk Factors. Annals of Emergency Medicine. 2012 2012/07/01/;60(1):24–32.
Daniels NF, Ridwan R, Barnard EB, Amanullah TM, Hayhurst C. A comparison of emergency department presentations for medically unexplained symptoms in frequent attenders during COVID-19. Clin Med (Lond). 2021 Jul;21(4):e399–e402. PubMed PMID: 34016583. Pubmed Central PMCID: PMC8313219. Epub 2021/05/22. eng.
Stieler M, Pockney P, Campbell C, Thirugnanasundralingam V, Gan L, Spittal MJ et al. Somatic symptom severity association with healthcare utilization and costs in surgical inpatients with an episode of abdominal pain. BJS Open. 2022 Jul 7;6(4). PubMed PMID: 35796068. Pubmed Central PMCID: PMC9260183. Epub 2022/07/08. eng.

No competing interests reported.

Download PDF

Journal Publication

published 18 Jul, 2024

Read the published version in BMC Emergency Medicine →

Editorial decision: Revision requested
05 Dec, 2023
Reviews received at journal
04 Dec, 2023
Reviewers agreed at journal
21 Nov, 2023
Reviews received at journal
26 Feb, 2023
Reviewers agreed at journal
26 Feb, 2023
Reviewers invited by journal
20 Feb, 2023
Editor assigned by journal
20 Feb, 2023
Editor invited by journal
23 Jan, 2023
Submission checks completed at journal
23 Jan, 2023
First submitted to journal
12 Dec, 2022

You are reading this latest preprint version

Functional Somatic Symptoms in Emergency Department Frequent Presenters

Status:

Journal Publication

Version 1

Abstract

Figures

Background

METHODS

Patient selection and data abstraction

Data Analyses

Results

Prevalence of FSS in Frequent ED Re-presenters

Age distribution

Gender and ethnicity

FSS amongst frequent ED presenters

Contributions of FSS categories to burden in ED re-presentations

Psychological Distress amongst ED Frequent presenters with FSS

Discussion

Implications

Limitations

Conclusions

Declarations

Competing interests

Consent of Publication

Authors' contributions

Acknowledgements

References

Additional Declarations

Status:

Journal Publication

Version 1