Detailed History of Review of Systems
A comprehensive review of systems (ROS) should include a systematic assessment of symptoms across all major body systems to identify potential health concerns that may not have been captured in the chief complaint or history of present illness. 1
General Components of Review of Systems
- The review of systems should be comprehensive and include questioning about common symptoms related to each body system, including fever, night sweats, weight loss, headaches, visual changes, oral issues, respiratory symptoms, chest pain, gastrointestinal symptoms, urinary symptoms, skin problems, neurological changes, and mental status changes 1
- For women, a menstrual history should be obtained as part of the review of systems 1
- Current weight should be compared with baseline, along with a dietary assessment 1
Specific Body Systems to Review
General System
- Unexplained weight loss, night sweats, fever, changes in body habitus 1
- Assessment of frailty and ambulatory ability 2
Skin System
- Skin discoloration, rash, ulcers, or lesions 1
- Assessment for seborrheic dermatitis, ecchymoses, purpura, petechiae, and other dermatological conditions 1
Head and Neck
- Localized or generalized enlargement of lymph nodes 1
- Head and neck examination including thyroid assessment 2
Eyes
Ears, Nose, and Throat
Respiratory System
Cardiovascular System
Gastrointestinal System
- Nausea, vomiting, abdominal pain, diarrhea, changes in bowel habits 1
- Assessment of appetite and nutritional status 2
Genitourinary System
- Urinary symptoms including frequency, urgency, dysuria 1
- For women: menstrual history and reproductive health 1
- Anogenital symptoms 1
Musculoskeletal System
Neurological System
- Changes in neurological function or mental status 1
- Assessment of cognition, memory, and concentration 1
- Headaches, dizziness, syncope, seizures 2
Psychiatric Assessment
- Depression screening (changes in mood, libido, sleeping patterns, appetite, concentration, and memory) 1
- Assessment for posttraumatic stress disorder and domestic violence 1
Special Considerations for Specific Patient Populations
- For patients with suspected neurological disorders, include assessment of timed gait, motor movements, reflexes, and Babinski signs 3
- For diabetic patients, include comprehensive foot examination with inspection of skin integrity, assessment of foot deformities, neurological assessment, and vascular assessment 3
- For elderly patients, include assessment of functional and cognitive performance, frailty, fall risk, and need for assistive devices 2
- For patients with cardiovascular concerns, include assessment of volume status, jugular venous pressure, and presence of peripheral edema 4
Documentation Requirements
- The review of systems should be documented in a systematic manner that clearly indicates which systems were reviewed and any positive or negative findings 2
- When fatigue is rated as moderate to severe (score of 4-10), a more focused history and physical examination should be conducted as part of the primary evaluation phase 1
- For patients with acute limb ischemia (ALI), the review of systems should focus on uncovering clinical evidence of conditions that can result in ALI, including atrial fibrillation, myocardial infarction, cardiomyopathy, valvular heart disease, aortic disease, and hypercoagulable states 1
Clinical Significance
- A comprehensive review of systems helps identify symptoms not mentioned in the chief complaint that may be relevant to diagnosis and treatment 2
- The review of systems is an essential component of the primary evaluation phase for patients with fatigue and can help determine various organ systems affected 1
- A thorough review of systems can guide the physical evaluation and diagnostic workup 1
Remember that the review of systems is a critical component of the medical evaluation that complements the history of present illness and helps ensure that important symptoms are not overlooked.