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Assess patient’s complaints for associated signs or pertinent negatives

Dig deep during the assessment to either rule out or rule in specific traumatic injury or illness


Photo courtesy MedStar

Our patient had fallen from his roof. He was supine on his driveway with C-spine stabilization, held by an emergency medical responder. The patient was awake, oriented and had normal vitals. In addition to asking OPQRST questions about pain, I wanted to learn if he had any associated symptoms of a spinal cord injury.

The patient denied:

  • Loss of consciousness
  • Neck pain
  • Spinal column pain
  • Sensory deficit
  • Motor function deficit

We expected to find associated signs in the presence of a specific traumatic injury or medical illness. If a spinal cord injury had occurred, I would have expected spinal column pain, sensory deficit, and/or motor deficit. He had none. Instead, I had a list of pertinent negatives, which are findings I checked for, but were not present.

Consider these possible associated signs or pertinent negatives for a patient with an abdominal pain complaint:

  • Fever
  • Blood in stool or urine
  • Persistent diarrhea
  • Persistent vomiting
  • Inability to empty bladder or bowels
  • Specific pain location
  • Radiating pain

Remember use OPQRST to start a conversation about pain. Ask additional questions to seek out pertinent negatives or associated symptoms.

This article, originally published May 11, 2009, has been updated

Greg Friese, MS, NRP, is the Lexipol Editorial Director, leading the efforts of the editorial team on Police1, FireRescue1, Corrections1 and EMS1. Greg served as the EMS1 editor-in-chief for five years. He has a bachelor’s degree from the University of Wisconsin-Madison and a master’s degree from the University of Idaho. He is an educator, author, national registry paramedic since 2005, and a long-distance runner. Greg was a 2010 recipient of the EMS 10 Award for innovation. He is also a three-time Jesse H. Neal award winner, the most prestigious award in specialized journalism, and the 2018 and 2020 Eddie Award winner for best Column/Blog. Connect with Greg on LinkedIn.