Screening
Common Reasons for Emergency Department Visits
ED visits are prompted by a wide array of symptoms and conditions, ranging from minor injuries to life-threatening emergencies. According to recent data, some of the most frequent reasons for seeking emergency care include:
Chest Pain: Often the most alarming symptom for patients, chest pain can be indicative of serious cardiovascular events such as a myocardial infarction (heart attack), pulmonary embolism, or aortic dissection. However, it can also be caused by less critical issues like gastroesophageal reflux disease (GERD) or musculoskeletal strain.¹
Abdominal Pain: This is another very common complaint with a broad differential diagnosis. Causes can range from benign conditions like gastroenteritis or indigestion to urgent surgical issues such as appendicitis, cholecystitis, or a bowel obstruction.²,³
Headache: While most headaches are benign, such as tension-type or migraine headaches, some can be a sign of a serious underlying condition like a subarachnoid hemorrhage, meningitis, or a brain tumor. A sudden, severe headache (thunderclap headache) is a significant red flag.⁴
Shortness of Breath (Dyspnea): Difficulty breathing can be related to a variety of pulmonary and cardiac conditions, including asthma, chronic obstructive pulmonary disease (COPD), pneumonia, heart failure, and pulmonary embolism.
Injuries: Falls are a leading cause of injury-related ED visits, especially among older adults. Other common injuries include motor vehicle accidents, cuts, and sprains.⁵
Fever: Often a sign of infection, fever is a common reason for ED visits, particularly in children. The underlying cause can range from a simple viral illness to more serious infections like sepsis or meningitis.
Back Pain: While often musculoskeletal in origin, back pain can occasionally be a symptom of a more serious condition such as a spinal cord compression or an aortic aneurysm.
The Role and Components of a Review of Systems
A review of systems (ROS) is a systematic inventory of the body's systems obtained through a series of questions to uncover signs and symptoms that the patient may not have spontaneously reported. A thorough ROS is essential for identifying potential "red flags" that may impact the safety of a physical therapy assessment and for contributing to an accurate diagnosis and appropriate discharge plan.
A comprehensive ROS typically includes the following systems:
Constitutional: General symptoms such as fever, chills, weight loss or gain, fatigue, and malaise.
Cardiovascular: Chest pain, palpitations, shortness of breath, orthopnea (shortness of breath when lying flat), paroxysmal nocturnal dyspnea (waking up with shortness of breath), and edema (swelling).
Respiratory: Cough, sputum production, hemoptysis (coughing up blood), wheezing, and shortness of breath.
Gastrointestinal: Abdominal pain, nausea, vomiting, diarrhea, constipation, changes in bowel habits, and blood in the stool.
Genitourinary: Dysuria (painful urination), frequency, urgency, hematuria (blood in the urine), and changes in urine stream.
Musculoskeletal: Joint pain, stiffness, swelling, muscle pain, and weakness.
Integumentary (Skin): Rashes, lesions, sores, and changes in skin color or temperature.
Neurological: Headache, dizziness, syncope (fainting), seizures, weakness, numbness, tingling, and changes in coordination or balance.
Psychiatric: Anxiety, depression, changes in mood, and cognitive changes.
Endocrine: Heat or cold intolerance, excessive thirst or urination, and unexplained changes in energy levels.
Hematologic/Lymphatic: Easy bruising, bleeding, and swollen lymph nodes.
Allergic/Immunologic: Rashes, hives, and a history of allergic reactions.
Tailoring the Review of Systems to Common ED Presentations
For common ED presentations, a focused ROS can help to quickly identify critical information.
For a patient with chest pain, key ROS questions include:
Cardiovascular: Any palpitations, shortness of breath at rest or with exertion, swelling in the legs?¹
Respiratory: Any cough, wheezing, or pain with breathing?
Gastrointestinal: Any nausea, vomiting, or a burning sensation in the chest after eating?
Musculoskeletal: Is the pain reproducible with movement or palpation of the chest wall?
For a patient with abdominal pain, key ROS questions include:
Gastrointestinal: Any nausea, vomiting, diarrhea, constipation, black or bloody stools? What is the relationship of the pain to eating?²
Genitourinary: Any pain with urination, blood in the urine, or changes in urinary frequency?
Constitutional: Any fever or chills?
For a patient with a headache, key ROS questions include:
Neurological: Any dizziness, vision changes, weakness, numbness, or difficulty with speech or coordination? Was the onset of the headache sudden and severe?⁴
Constitutional: Any fever or neck stiffness?
Head and Neck: Any jaw pain with chewing or tenderness over the temples?
By systematically gathering this information, acute care physical therapists can contribute significantly to the interdisciplinary team's understanding of the patient's condition. This comprehensive approach ensures that mobility assessments are conducted safely and that discharge recommendations are well-informed, ultimately leading to better patient outcomes.
References
Stiell IG, Clement CM, Brison RJ, et al. A risk scoring system to identify emergency department patients with heart failure at high risk for serious adverse events. Acad Emerg Med. 2013;20(1):17-26.
Cartwright SL, Knudson MP. Evaluation of acute abdominal pain in adults. Am Fam Physician. 2008;77(7):971-978.
Penner RM, Fishman MB. Evaluation of the adult with abdominal pain. In: UpToDate. Post TW, ed. UpToDate; 2023.
Graber MA, Toth GR, Herting RL. University of Iowa Family Practice Handbook. 4th ed. Mosby; 2004.
Centers for Disease Control and Prevention. National Hospital Ambulatory Medical Care Survey: 2018 Emergency Department Summary Tables. https://www.cdc.gov/nchs/data/nhamcs/web_tables/2018-ed-web-tables-508.pdf. Published 2021. Accessed August 12, 2025.