Skip to main content
  • Letter to the Editor
  • Open access
  • Published:

A common definition should be used in future studies of NSC

Dear Editor,

We have read with great interest a recent commentary, “How should nonspecific complaints be defined? Comment to: “nonspecific complaints (NSCs) in the emergency department” [1] concerning our systematic review [2].

In the commentary, our decision not to include studies by the BANC group was questioned. As the BANC group has laid a solid groundwork for the study of NSC, we have cited the BANC group studies throughout our review, starting with the definition of NSC. As the concept as defined by Nemec et al. is relatively new [3] and many authors have used different names for the condition (for example Djärv et al. [4]), we extended the search terms and included studies beyond this definition. Indeed, the BANC group itself suggests that the presentation of generalized weakness should be subsumed to NSC [5].

The BANC group is referring to their original definition of NSC excluding patients in triage categories 1,4 and 5. Triage for the older adults is challenging, and especially challenging when there is a lack of a specific complaint [6]. In our opinion, if a patient without a specific complaint was occasionally triaged into these excluded categories, they would still be presenting with an NSC.

In our article, we have stated the exclusion criterion of many studies from the BANC group being the patient selection in only two out of five triage categories. However, this was merely the shared attribute in the BANC group studies, and we regret having expressed the exclusion criteria poorly. Detailed reasons for exclusion of potentially relevant studies can be inspected in Appendices 2 and 3 of our review.

Not many studies have been published on NSC, and even those are heterogenous. This is reflected in our review, which is the first of its kind. We wholeheartedly agree with the BANC group, that studies on this topic should be based on a common definition to improve the quality of future reviews.

Availability of data and materials



  1. Bingisser R, Nickel CH. How should nonspecific complaints be defined? Comment to: “nonspecific complaints (NSCs) in the emergency department”. Scand J Trauma Resusc Emerg Med. 2020;28(1):110.

  2. Kemp K, Mertanen R, Lääperi M, Niemi-Murola L, Lehtonen L, Castren M. Nonspecific complaints in the emergency department - a systematic review. Scand J Trauma Resusc Emerg Med. 2020;28(1):6.

  3. Nemec M, Koller MT, Nickel CH, Maile S, Winterhalder C, Karrer C, et al. Patients presenting to the emergency department with non-specific complaints: the Basel non-specific complaints (BANC) study. Acad Emerg Med [Internet]. 2010;17(3):284–92.

    Article  Google Scholar 

  4. Castren M, Kurland L, Liljegard S, Djarv T. Non-specific complaints in the ambulance; predisposing structural factors. BMC Emerg Med. 2015;15:8.

    Article  Google Scholar 

  5. Nickel CH, Malinovska A, Bingisser R. Should weakness be subsumed to nonspecific complaints?-correspondence inresponse to Bhalla et al. Am J Emerg Med. 2015;33(5):722–3.

    Article  CAS  Google Scholar 

  6. Platts-Mills TF, Travers D, Biese K, McCall B, Kizer S, LaMantia M, et al. Accuracy of the emergency severity index triage instrument for identifying elder emergency department patients receiving an immediate life-saving intervention. Acad Emerg Med Off J Soc Acad Emerg Med. 2010;17(3):238–43.

    Article  Google Scholar 

Download references





Author information

Authors and Affiliations



All authors read and approved the final manuscript.

Corresponding author

Correspondence to Kirsi Kemp.

Ethics declarations

Ethics approval and consent to participate


Consent for publication


Competing interests


Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kemp, K., Mertanen, R., Niemi-Murola, L. et al. A common definition should be used in future studies of NSC. Scand J Trauma Resusc Emerg Med 29, 33 (2021).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: