Duration of Symptoms in the Review of Systems
No, the duration of symptoms should not be included in the Review of Systems (ROS) section—it belongs in the History of Present Illness (HPI). The ROS is a systematic inventory of symptoms across body systems to identify issues not captured in the chief complaint, while symptom duration is a temporal characteristic that defines the presenting illness 1, 2.
What Belongs in the ROS
The ROS should document the presence or absence of symptoms across major body systems, not their temporal characteristics 1, 2. According to the Infectious Diseases Society of America guidelines, a comprehensive ROS includes:
- Constitutional symptoms: fever, night sweats, weight loss, changes in body habitus 1, 2
- Skin: rashes, lesions, discoloration 1, 2
- Cardiovascular: chest pain, palpitations, orthopnea 1, 2
- Respiratory: cough, shortness of breath, wheezing 1, 2
- Gastrointestinal: nausea, vomiting, abdominal pain, diarrhea 1, 2
- Genitourinary: dysuria, discharge, hematuria 1, 2
- Neurological: headaches, memory changes, weakness 1, 2
- Psychiatric: mood changes, depression, anxiety 1
Where Duration Belongs
Symptom duration is a core component of the HPI, not the ROS 1. Multiple guidelines emphasize that temporal factors—including onset, duration, and episodicity—should be clearly documented when characterizing the presenting complaint 1, 3. The 2004 consensus workshop on symptom evaluation explicitly states that "timescale of symptom evaluation and/or duration of symptoms should always be clearly stated in any reporting of symptom status" as part of symptom characterization, not system review 1.
For clinical trial design, duration of symptoms relative to key time points (hospitalization, randomization, treatment initiation) must be documented separately from the symptom inventory 1.
Clinical Rationale
This distinction serves important purposes:
- The ROS functions as a screening tool to identify symptoms across all body systems that may not be related to the chief complaint 2, 4
- The HPI provides detailed characterization of the presenting problem, including onset, duration, severity, and progression 1, 3
- Mixing temporal data into the ROS would blur the distinction between systematic screening and focused problem assessment 5
Research on physician information needs confirms that clinicians view the ROS primarily as a checklist, with the HPI and Assessment/Plan sections containing the clinically actionable temporal and contextual details 5.
Common Pitfall to Avoid
Do not document "patient has had cough for 3 weeks" in the respiratory section of the ROS. Instead, document "cough: present" in the ROS, and reserve the 3-week duration for the HPI where it provides context for the presenting illness 1, 5. This maintains the ROS as an efficient screening tool while ensuring temporal information is captured where it belongs 2, 5.