Purpose and Background:
Patients are commonly admitted to an emergency department (ED) with one or more primary symptoms. The initial workup and subsequent monitoring are driven by both the symptoms and the underlying diagnosis and prognosis. Knowledge of the association between symptoms, diagnosis, and prognosis is therefore important to optimize treatment and improve patient outcomes.
The primary aim of this study was to describe the relationship between presenting symptoms and underlying diagnosis in patients admitted to EDs in a cohort of patients in the Region of Southern Denmark (RSD). The secondary aim was to examine the length of stay (LOS), transfers to the intensive care unit (ICU), readmissions, and mortality in relation to the chief complaints.

Material and Methods:
We included acute hospital contacts 18 years or older referred to seven different hospitals in RSD from January 2016 to March 2018. At triage, patients have an acute package assigned identifying them according to their chief complaints. Outcome variables were diagnoses, mortality, readmission, ICU transfer, and LOS.

Results:
In total, 297,086 acute contacts were included. Mean age 58 years (SD 21). 50.9% women. The five most frequent symptoms for referral were: unspecific complaints (17.0%), abdominal pain (12.9%), dyspnea (9.2%), fever (6.6%), and chest pain (6.0%). In 22.6% of the cases, information about the primary complaint was missing. Patients were often discharged with either an observational (14.95%) or a symptom-based diagnosis (5.59%). Among the specific diagnoses’ pneumonia (2.34%), chronic obstructive lung disease (1.4%), and dehydration (1.1%) were the most frequent. Dyspnea was associated with the highest 7- and 30-day mortality (8.5% and 10.8%), most transfers to the ICU (16.6%), and readmissions within 7 and 14 days (17.3% and 9.2%). Patients with fever had the longest LOS (4.8 days).

Discussion and Conclusion:
Patients are primarily admitted and discharge with unspecific complaints and an unspecific diagnose. Dyspneic patients presented the highest mortality, number of ICU transfers, and readmissions.