Emergency Department Utilization According to Patient Age and Type of Presenting Complaints: A Narrative Review

Abstract

Background: The number of patients presenting to hospital emergency departments (EDs) has been consistently increasing. Patients present with a wide spectrum of complaints, from specific symptoms directing diagnostic evaluation to entirely non-specific ones, and their clinical relevance varies with age.

Aim: To summarize and compare presenting complaints reported by ED patients across age groups and to discuss their association with clinical outcomes.

Material and methods: A literature search was performed in PubMed (MEDLINE) to identify publications on presenting complaints in ED patients. Case reports, case series, letters, editorials, and commentaries were excluded. Only English-language full-text studies were included; no date restrictions were applied.

Results: The spectrum of presenting complaints is broadly similar across age groups, whereas their frequency differs substantially with age. ED utilization is highest at the extremes of age. In children, infectious complaints (fever, respiratory and gastrointestinal symptoms) and injuries dominate, and hospitalization rates are low. In adults, the spectrum is more heterogeneous, and many patients are discharged with a symptom-based rather than definitive diagnosis. In older adults, non-specific complaints such as fatigue, weakness, and confusion become one of the most common reasons for presentation; their proportion rises with age and they are associated with higher hospitalization and mortality rates than complaints traditionally regarded as more urgent. The same complaint may carry a markedly different prognosis depending on age.

Conclusions: Both the frequency of presenting complaints and their clinical consequences in the ED are strongly age-dependent. The presenting complaint should be interpreted together with patient age, as a complementary component of risk assessment. Older patients with non-specific complaints warrant particular attention as a group at increased risk of adverse outcomes.