Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Interventions for medically unexplained symptoms in the emergency department

a critical literature review

Lennox, George A. K.a; Kendall, Richardb

European Journal of Emergency Medicine: May 23, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/MEJ.0000000000000613
Review article: PDF Only

Medically unexplained symptoms, defined as physical symptoms for which no organic pathology can be found, represent 4% of all emergency department attendances annually. The standard management of these patients involves extensive investigation to rule out organic pathology, followed by simple reassurance. We conducted a literature review to determine if there was any intervention that could improve these patient’s symptoms and reduce emergency department attendances. A search of MEDLINE, EMBASE and PsycINFO yielded 1612 unique citations, of which six studies met inclusion criteria. The studies were heterogeneous in terms of the participants involved, interventions tested and conclusions drawn. Three studies tested cognitive behavioural therapy, with two finding a reduction in emergency department attendance. Overall, evidence regarding interventions for patients with medically unexplained symptoms in the emergency department is limited and of a variable quality, despite comprising 4% of emergency department attendances. Further research is required to determine the best intervention for this challenging patient group.

aUniversity of Cambridge School of Clinical Medicine

bEmergency Department, Cambridge University Hospitals, Cambridge, UK

Received 20 March 2019 Accepted 13 May 2019

Correspondence to George A.K. Lennox, BA, University of Cambridge School of Clinical Medicine, Box 111 Cambridge Biomedical Campus, Cambridge, CB2 0SP, Tel: +441223336700; fax: +441223336709; e-mail:

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.