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

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

Observations

(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

Observations

(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