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Reduced range of facial expression may indicate serious cardiopulmonary disease
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Patients with serious cardiopulmonary disease may not exhibit the normal range of facial expressions, particularly the ability to register surprise in response to emotional cues, upon admission to the ED, according to preliminary research published in Emergency Medicine Journal.
“Our preliminary findings suggest that stimulus-evoked facial expressions from emergency department patients with cardiopulmonary symptoms might be a useful component of gestalt pretest probability assessment,” the investigators wrote.
The single-center, prospective pilot study included 50 adults who presented to the ED with dyspnea and chest pain between May and September 2011. Participants were shown three slides on a laptop computer that were intended to change facial expression for 10 seconds each, as the investigators recorded their expressions upon viewing the slides. The first two slides were intended to depict humor and the third to elicit sadness, according to the study details.
Expressions of “smile,” “surprise” and “frown” were analyzed for each slide according to the Facial Action Coding System (FACS), with maximum assigned values of 20, 15 and 5, respectively. Participants also underwent CT pulmonary angiography and were followed for 14 days for diagnosis of serious cardiopulmonary disease, including ACS, pulmonary embolism, pneumonia, serious aortic or esophageal conditions, or cancer.
“The ultimate goal of this work is to provide clinicians with a new physical finding that can be associated with a healthy state to avoid unnecessary CT [pulmonary angiography] scanning,” the researchers wrote.
During follow-up, 16% of participants were diagnosed with serious cardiopulmonary disease. When total FACS scores for each patient were assessed, the median value for all three slides was numerically, but not significantly, lower among those with serious cardiopulmonary disease (13.5 compared with 27.5; P=.14). However, median FACS values for the first stimulus slide to elicit humor, specifically, were significantly lower for patients with serious cardiopulmonary disease than those of patients without serious cardiopulmonary disease (3.4 compared with 7; P=.019).
Expression of surprise was associated with the largest difference among patients with and without serious cardiopulmonary disease (area under the curve, 0.752; 95% CI, 0.52-0.87).
“In this preliminary study, we found that patients with chest pain and dyspnea who had a potentially serious cardiopulmonary diagnosis had significantly lower facial expression valence in response to a visual stimulus,” the researchers wrote. “… Taken another way, patients with serious cardiopulmonary diseases tended to hold their faces neutral when watching visual stimuli.”
Disclosure: The researchers report no relevant financial disclosures.
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