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Table 4 Summative review of discussion and recommendations of categories removed, added and changed

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

(change category)
Discussion Recommendation
Abscess often misdiagnosed Abscess is a diagnosis rather than a complaint, associated with rash/skin lesion in group factor analysis Remove abscess
Bleeding often grouped with wound and pain Bleeding from injury was associated with wound and pain in group factor analysis, does not contribute helpful information Remove bleeding from injury
Foreign body from injury represented < 0.5% of visits Could be captured in “wound from injury”; doesn't affect resource allocation Remove foreign body from injury
Foreign body inhaled was never checked Not frequent enough to warrant its own category Remove foreign body inhaled
Pain was checked in 59% of 3537 visits Does not provide meaningful information or impact allocation of resources Remove pain
Suspected flu/cold represented < 0.5% of visits Does not provide meaningful information or impact allocation of resources Remove suspected flu/cold
Unable to eat is not specific for any disease process Could be captured with other general complaints (generalized weakness/fatigue, Weight loss/wasting, etc.) Remove unable to eat
Suspected HIV represented < 0.5% of visits Important category for resource allocation/epidemiology No change recommended
Suspected malaria was never checked Likely underrepresented in South Africa due to low malaria prevalence No change recommended
Swelling Difficult to discern generalized edema vs focal swelling Place under limb heading to encourage focal use
(add category)
Discussion Recommendation
Back pain not on list Represented 1.8% of complaints; non-traumatic back pain managed differently than traumatic back pain Add new category: back pain
Burn Represented 0.9% of complaints; burns in LMICs have a significant impact on morbidity and mortality, our count is likely not representative of true incidence Add new category: burn
Joint/MSK pain not on list Represented about 1.8% of complaints; more specific than pain Add category: joint or limb pain
Sexual assault is not captured on this form Sexual assault is a large and under reported problem in LMIC, this is a chance to gain more accurate data Add new category: sexual assault (under known injury intent, or genital heading)
Suspected tuberculosis not on list Important category for resource allocation/epidemiology Add new category: suspected tuberculosis
Unresponsive not on list Frequently (1.64%) selected in Uganda chief complaint study; distinct entity from confusion/fatigue Add new category: unresponsive
(change category)
Discussion Recommendation
Abnormal BP Patients unlikely to present with “low BP” as a chief complaint Change to high blood pressure
Heart beat Even though this is low frequency, we suspect that it was underutilized due to poor understanding of “heart beat” Change to abnormal heart rate
Blood in cough/nose Epistaxis can be captured by Ear/Nose/Mouth Change to coughing/vomiting blood
Blood in urine represented < 0.5% of visits, Likely underrepresented in South Africa due to low schistosomiasis prevalence, too specific Change to urinary problem
Bloody D/V involved in several mismatches Bloody diarrhea deserves its own category to capture dysentery cases; move bloody vomiting to coughing/vomiting blood as above Change to bloody diarrhea
Confusion/AMS represented < 0.5% of visits “AMS” is not lay terminology Change to confusion
Decrease urine output Too specific, can combine with blood in urine Change to urinary problem
Dental represented < 0.5% of visits Low frequency complaint, associated with ENT in group factor analysis, thus can merge with ENT Merge “dental” and "ENT" into "ear/nose/mouth"
Diarrhea/constipation Diarrhea important cause of morbidity and mortality worldwide, warrants its own category Split into non-bloody diarrhea and constipation
ENT represented < 0.5% of visits, involved in several mismatches ENT is not lay terminology; also, likely unknown term outside of Western medicine Change to ear/nose/mouth
Focal weak/numb was involved in several mismatches Attempting to capture large strokes with one category Change to limb weakness/facial droop