Top Ten Most Common Chief Complaints in Emergency Medicine
The ten most common chief complaints in emergency medicine are chest pain, shortness of breath, abdominal pain, headache, altered mental status, weakness/dizziness/lightheadedness, nausea/vomiting/dehydration, fever, pain (non-specific), and traumatic injuries. These complaints represent the majority of presentations to emergency departments and require systematic evaluation approaches.
1. Chest Pain
Chest pain accounts for approximately 11.5% of emergency department visits 1. It requires immediate assessment due to its association with potentially life-threatening conditions.
- Presentation characteristics: Central/substernal compression or crushing chest pain; pressure, tightness, heaviness, cramping, burning, or aching sensation; radiation to neck, jaw, shoulders, back, or arms 2
- Associated symptoms: Dyspnea, nausea/vomiting, diaphoresis 2
- Key considerations:
2. Shortness of Breath (Dyspnea)
Dyspnea represents approximately 7.4% of emergency department visits 1 and is associated with higher mortality than many other complaints.
- Key considerations:
3. Abdominal Pain
Abdominal pain accounts for approximately 11.1% of emergency department visits 1.
- Presentation characteristics: May be localized or diffuse; can be described as cramping, sharp, dull, or burning
- Key considerations:
4. Headache
Headache is one of the most common neurological complaints in emergency departments.
- Key considerations:
- May represent benign conditions or life-threatening emergencies (subarachnoid hemorrhage, meningitis)
- Requires careful assessment of "red flag" symptoms (sudden onset, worst headache of life, neurological deficits)
- Neuroimaging indicated for specific presentations 2
5. Altered Mental Status
Altered mental status accounts for 4-10% of emergency department chief complaints 2.
- Presentation characteristics: Confusion, disorientation, lethargy, drowsiness, somnolence, unresponsiveness, agitation, altered behavior, inattention, hallucinations, delusions, or behaving inappropriately 2
- Key considerations:
6. Weakness/Dizziness/Lightheadedness
This constellation of symptoms is a common presentation requiring careful evaluation.
- Key considerations:
- May represent cardiovascular, neurological, metabolic, or other systemic disorders
- Requires assessment for stroke, cardiac arrhythmias, orthostatic hypotension, and metabolic disorders
- Listed as requiring immediate assessment by triage nurses 2
7. Nausea/Vomiting/Dehydration
These symptoms frequently bring patients to emergency departments and are among the most common complaints in cancer patients 4.
- Key considerations:
- May represent gastrointestinal, metabolic, neurological, or toxicological disorders
- Requires assessment of hydration status and electrolyte abnormalities
- Often associated with abdominal pain or other systemic symptoms
8. Fever
Fever is a common presentation that may indicate infection or inflammatory conditions.
- Key considerations:
- May represent localized or systemic infections
- Requires assessment for sepsis criteria and source identification
- Higher risk in immunocompromised, very young, or elderly patients
9. Pain (Non-specific/Other)
Pain at various sites (excluding chest, abdomen, and head) is a frequent presentation.
- Key considerations:
- May represent musculoskeletal, neurological, vascular, or other conditions
- Requires assessment of location, quality, radiation, and associated symptoms
- Pain and headache together represent a significant proportion of ED visits 5
10. Traumatic Injuries
Various traumatic injuries round out the top ten chief complaints.
- Key considerations:
- Include falls, motor vehicle accidents, assaults, and other mechanisms
- Require systematic assessment based on trauma protocols
- Severity ranges from minor to immediately life-threatening
Clinical Implications
Emergency departments must be prepared to rapidly triage and evaluate these common presentations. The American College of Cardiology/American Heart Association guidelines emphasize the importance of immediate assessment for patients with concerning symptoms like chest pain 2.
It's important to note that many emergency department patients (approximately 37-45%) do not receive a pathological diagnosis that explains their symptoms 5. This highlights the diagnostic challenges in emergency medicine and the need for systematic approaches to these common complaints.
Common Pitfalls
Failing to recognize atypical presentations: Women, elderly patients, and those with diabetes may present with atypical symptoms, particularly for cardiac conditions 2
Attributing symptoms to age or pre-existing conditions: This is especially problematic with altered mental status in elderly patients 3
Inadequate triage: Delayed recognition of time-sensitive conditions can increase morbidity and mortality
Overreliance on diagnostic testing: Clinical assessment remains fundamental despite technological advances 3
Premature diagnostic closure: Assuming a benign cause before excluding serious pathology
Understanding these common chief complaints and their potential underlying causes is essential for effective emergency department operations and optimal patient outcomes.