What are the common conditions, treatments, and diagnosis for a general adult population presenting to urgent care with no specified underlying medical conditions?

Common Conditions, Treatments, and Diagnoses in Urgent Care Settings

Most Common Presenting Conditions

Adults presenting to urgent care facilities most commonly seek treatment for minor acute illnesses, musculoskeletal injuries, and upper respiratory infections, which collectively account for the majority of non-emergency visits. 1

Primary Complaint Categories

• Musculoskeletal pain represents approximately 25% of non-urgent presentations, including minor strains and fractures that can be managed outside traditional emergency departments 1, 2
• Upper respiratory tract infection symptoms account for nearly 20% of visits, presenting as cough, congestion, sore throat, and related complaints 2
• Minor acute illnesses encompass conditions like urinary tract infections, gastroenteritis, and skin infections that require evaluation but not emergency-level resources 1

Less Common but Important Presentations

• Dyspnea (shortness of breath) requires careful evaluation to distinguish cardiac from non-cardiac causes, with BNP/NT-proBNP testing showing high sensitivity (90-99%) when clinical suspicion exists 3
• Psychiatric symptoms including anxiety, depression, and behavioral concerns, though these may mask underlying medical conditions requiring evaluation 3, 4
• Neurological complaints such as headache, dizziness, or altered mental status, which have the lowest diagnostic agreement rates (81.5%) in prehospital settings due to symptom overlap 5

Diagnostic Approach Framework

History-Directed Evaluation Strategy

The American College of Emergency Physicians recommends directing diagnostic evaluation by history and physical examination findings rather than obtaining routine laboratory testing on all patients. 3, 4

Essential Historical Elements

• Medication history including all prescription drugs, over-the-counter medications, herbal supplements, and recent changes in dosing 6
• Substance use screening for tobacco, alcohol, and illicit drugs, as these directly influence presentation and management 6
• Chronic medical conditions including diabetes, hypertension, cardiac disease, and immunocompromised states 6
• Prior psychiatric history with specific treatment details, medication responses, and hospitalizations when behavioral complaints are present 4, 7

Physical Examination Priorities

• Vital signs documentation is mandatory, as abnormal temperature, blood pressure, heart rate, or respiratory rate necessitates broader medical workup regardless of presenting complaint 4, 6
• Mental status assessment including orientation, cognition, and behavior to identify delirium or acute confusion 4, 6
• Focused neurological examination as this is the most commonly omitted component yet critical for accurate diagnosis 3, 5

High-Risk Populations Requiring Lower Diagnostic Thresholds

Elderly patients, those without prior psychiatric history, patients with substance abuse, and those presenting with new-onset symptoms require comprehensive medical evaluation before attributing symptoms to benign causes. 3, 4, 6

• Elderly patients present with atypical symptoms, have higher rates of cognitive impairment, and experience delayed diagnosis contributing to worse outcomes 8
• New-onset psychiatric symptoms require particularly careful medical evaluation, as most have medical illness as the underlying etiology 4
• Patients unable to provide complete history (nursing home residents, cognitively impaired, language barriers) have significantly lower diagnostic accuracy rates 5

Common Diagnostic Pitfalls and How to Avoid Them

Neurological Presentations

• Postictal states after unwitnessed seizures are frequently misdiagnosed as cerebrovascular accidents, representing the most common diagnostic error in urgent care settings 5
• Obtain collateral history from witnesses, family, or emergency medical services to clarify the timeline and nature of symptom onset 5

Psychiatric Presentations Masking Medical Illness

• Never assume psychiatric etiology without structured cardiac risk assessment in patients with tachycardia, palpitations, or chest discomfort 6
• Screen for focal neurological deficits and obtain comprehensive metabolic evaluation when altered mental status, disorientation, or confusion is present 4, 6
• Recognize that somatic complaints (headache, gastrointestinal distress, back pain) frequently mask underlying depression, anxiety, or suicidal ideation in patients who later complete suicide 3

Cardiac Presentations in Psychiatric Patients

• Document all QT-prolonging medications as antipsychotics carry a 4.09 odds ratio for severe tachycardia 6
• Obtain family history of sudden cardiac death in young relatives, suggesting inherited arrhythmogenic syndromes 6
• Never dismiss tachycardia as "anxiety" without excluding cardiac causes through structured assessment 6

Treatment Approach by Condition Category

Minor Acute Illnesses

• Upper respiratory infections typically require symptomatic management, with antibiotic prescribing reserved for bacterial infections meeting clinical criteria 2
• Urinary tract infections can be diagnosed with urinalysis and treated with appropriate antibiotics based on local resistance patterns 1
• Skin and soft tissue infections require assessment for abscess formation necessitating incision and drainage versus cellulitis manageable with oral antibiotics 1

Musculoskeletal Injuries

• Minor strains and sprains respond to rest, ice, compression, elevation (RICE protocol), NSAIDs, and activity modification 1
• Simple fractures require radiographic confirmation, immobilization, and orthopedic follow-up rather than emergency department transfer 1

Dyspnea Evaluation

• BNP testing with age-adjusted cutpoints (300 pg/mL for age <50,450 pg/mL for age 50-75,900 pg/mL for age >75) provides 96-99% sensitivity for acute heart failure when combined with clinical judgment 3
• Obesity reduces BNP levels, requiring lower diagnostic thresholds (BMI <20: cutpoint 81 pg/mL; BMI 20-25: 104 pg/mL; BMI >25: 64 pg/mL) 3
• Renal insufficiency elevates BNP, necessitating higher cutpoints (GFR 60-89: 104 pg/mL; GFR 30-59: 201 pg/mL; GFR <30: 225 pg/mL) 3

Psychiatric Symptom Management

Deploy standardized screening instruments systematically rather than relying solely on clinical gestalt to improve diagnostic accuracy. 4, 7

• Use APA Level 1 Cross-Cutting Symptom Measures to screen for anxiety, depression, and psychosis before clinical evaluation 4, 7
• Obtain collateral information from family members and prior providers, as patients frequently minimize symptom severity 7
• Assign provisional diagnoses with mandatory longitudinal follow-up, as patients often present acutely before meeting full duration criteria for definitive diagnosis 4, 7
• Avoid routine laboratory testing unless history or examination suggests medical etiology; only 0.8% of screening tests in psychiatric patients contribute meaningfully to diagnosis 3

Disposition and Follow-Up

Appropriate Urgent Care Management

• 13.7-27.1% of emergency department visits could be safely managed at urgent care centers with potential cost savings of $4.4 billion annually 1
• Conditions appropriate for urgent care include minor acute illnesses, simple fractures, strains, and presentations not requiring advanced imaging or intensive monitoring 1

When to Transfer to Emergency Department

• Respiratory distress with SpO2 <90% on non-rebreather mask, respiratory acidosis with pH <7.2, or clinical evidence of impending respiratory failure 3
• Hypotension (SBP <90 mmHg) with clinical shock refractory to volume resuscitation 3
• Altered mental status with focal neurological deficits, abnormal vital signs, or cognitive impairment suggesting acute medical illness 4, 6
• Cardiac symptoms in high-risk patients (elderly, known cardiac disease, family history of sudden death, multiple risk factors) 6

Mandatory Follow-Up Arrangements

• Psychiatric presentations require longitudinal reassessment as misdiagnosis is common at illness onset, with some patients remitting before meeting full diagnostic criteria 4, 7
• Neurological symptoms need close follow-up given the 81.5% diagnostic agreement rate and potential for evolving presentations 5
• All patients should receive clear return precautions and instructions for accessing care if symptoms worsen or new concerning features develop 1