Assess patient's complaints for associated signs or pertinent negatives

Updated February 11, 2015

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

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.

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