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Table 2 Mismatches identified and resulting recommendations

From: Calibrating a chief complaint list for low resource settings: a methodologic case study

Chief complaint (n) Discussion Recommendation
Abdominal pain (22) Only pain checked; provider did not keep searching for proper CC Remove pain
Abnormal blood pressure (1) Only pain checked; provider did not keep searching for proper CC Change to high blood pressure
Abnormal glucose (2) Only pain checked; provider did not keep searching for proper CC Remove pain
Abscess (5) Pain checked/too general, can be captured in rash/skin problem Remove abscess
Alcohol/drug problem (2) Medication issue checked instead of alcohol Change to poisoning/alcohol/drug problem
Blood in cough/nose (1) Hemoptysis and epistaxis are separate entities Change to coughing/vomiting blood, as epistaxis can be captured by ear/nose/mouth
Bloody D/V (4) Bloody diarrhea deserves its own category to capture dysentery cases; move bloody vomiting to coughing/vomiting blood Change to bloody diarrhea to capture dysentery
Chest pain (11) Pain checked; provider did not keep searching for proper CC Remove pain
Confusion/AMS (1) AMS is not lay terminology Change to confusion
Decreased urine output (1) Pain checked; provider did not keep searching for proper CC Remove pain
Diarrhea/constipation (2) Pain checked; provider did not keep searching for proper CC Remove pain
ENT (12) ENT is not lay terminology; also, likely unknown term outside of Western medicine Change to ear/nose/mouth
Eye problem (2) Issues unrelated to eye problem Remove abscess
Focal weak/numb (2) Issues unrelated to focal weak/numb, however can capture stroke-like symptoms in one broad category Limb weakness/facial droop Change to limb weakness/facial droop
Fracture/deformity (2) Pain checked; provider did not keep searching for proper CC No change recommended
Generalized weakness (2) Pain checked; provider did not keep searching for proper CC Remove pain
GU complaint (15) GU is not lay terminology; maybe out of cultural context. Often checked for rectal complaints Remove GU complaint, add urinary problem, penis/vagina problem or genital problem, and rectal problem
Headache (3) Occasionally checked in context of traumatic injury No change recommended
Mass (1) Not very specific Change to suspected cancer/mass
Nausea/vomiting (3) Pain checked; provider did not keep searching for proper CC Remove pain
Pain (3) Only three instances where Pain could have better described the intended CC; thousands of instances where pain was checked when another CC could provide more useful data Remove pain
Pregnancy complication (1) Complication not lay terminology Change pregnancy complication to pregnancy problem
Psychiatric illness/SI (1) Was not checked when it should have been No change recommended
Rash/skin lesion (4) Lesion not lay terminology Change to rash/skin problem
Seizure/convulsion (4) Convulsion not lay terminology Change to fits/seizure
Shortness of breath (5) May be out of cultural context Change to breathing problem
Speech problem (1) Was not checked when it should have been No change recommended
Swelling (2) Unclear whether refers to generalized edema or focal swelling No change recommended; will place under limb/swelling heading to discourage use for skin complaints
Syncope/fainting (2) Syncope not lay terminology Change syncope/fainting to fainting/dizziness
Vaginal bleeding (2) Issues unrelated to vaginal bleeding No change recommended
Generalized weakness Was not ticked in cases of fatigue or just weakness, thus modified to be more inclusive Change to generalized weakness/fatigue
GU complaint involved in several mismatches GU is not lay terminology and was frequently used inappropriately for rectal complaints; likely unknown term outside of Western medicine. Difficult to find a ubiquitous term for these complaints Change to genital problem
Mass represented < 0.5% of visits It seems as if trying to capture concern for cancer, but was often not ticked because not explicit enough Change to suspected cancer/mass
Medication issue represented < 0.5% of visits Unsure what this is trying to capture Combine with poisoning/ingestion/medication problem
Wound Not specific enough and staff did not understand Change to wound from injury