ED chief complaint categories for a medical student curriculum

BACKGROUND It is important to stimulate the interest of all medical students in emergency medicine to further its growth nationally and internationally. Students focused on other specialties can benefit from exposure to the more common, less acute problems seen in the emergency department (ED). AIMS We developed a categorization system for chief complaints (CC) in an academic ED fast track (FT) area, so that a curriculum based upon actual CC and clinical experience could be designed for learners. METHODS Primary (first) FTCCs were obtained from the ED electronic record of an academic medical center from 1 to 10 July 2006 and 1 to 10 February 2007. Category definitions were developed, and CCs were collapsed into clinically coherent groups. Inter-rater reliability was assessed, and CC categories were compared for the two study periods. The study was exempted by the University Institutional Review Board. RESULTS In the July data set, 493 CCs were placed into 8 categories which captured 96.3% of CCs: pain 32.3%, injury 26.6%, infection 15%, psychiatric 8.1%, miscellaneous 6.1% (those with a frequency of </= 2%), nurse only visit 5.5%, eye 4.3% and rash 2.2%. The weighted kappa for CC categorization between two observers was 0.8980 (95% confidence interval: 0.8638-0.9322). In the February data set, refinements with 454 CCs resulted in categorization of 96.9% of the CCs into the same 8 categories with 53 subcategories. The distribution of the major categories was similar in July and February (p = 0.13). CONCLUSIONS The FTCC categorization was valid and reliable and can guide curriculum development for learners in an academic setting.