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Facial expressions could give doctors a life-saving clue

Emergency room doctors may be able to tell just how sick certain patients are by observing their facial expressions, according to new paper published in Emergency Medicine Journal.

The study found patients with serious -- and sometimes life-threatening -- heart or lung problems tend to have less than the normal range of facial expression, particularly when it comes to registering surprise in response to certain emotional cues.

For the study, researchers at Carolinas Medical Center assessed 50 adults with shortness of breath and chest pain. Each patient viewed three visual cues on a laptop, all of which were meant to evoke an emotional response: a humorous cartoon, a close-up of a surprised face and a picture of someone crying. A computer webcam recorded the patient's changing facial expression during the viewing.

The researchers then used the Facial Action Coding System -- a program that analyzes facial muscle activity when a person smiles, frowns or is surprised -- to evaluate the video of each patient.

Doctors also screened each patient for both chronic and acute heart and lung problems, including heart attack, unstable angina, pulmonary embolism (blood clot in the lung), cancer, pneumonia and problems of the aortic artery or gut. All study participants were monitored for 14 days after they were screened.

The researchers reported that during those two weeks, 16 percent -- 8 people -- developed serious heart or lung disease. Out of the remaining 42 study participants, two developed worsening chronic obstructive pulmonary disease, two presented with heart failure and one was found to have atrial fibrillation.

An analysis of the webcam footage determined that patients with chest pain and shortness of breath with potentially serious heart and lung conditions tended to have significantly less range in facial expression than those who were healthier. Overall patients who were seriously ill were much more likely to maintain neutral facial expressions in reaction to the visual cues viewed on the computer.

The authors speculate underlying serious illness makes it more challenging for the person to process emotions as a healthy person would.

In an emergency room setting, doctors make decisions about a patient's course of treatment by using both objective and subjective screening measures. Some of the most effective ways to assess a patient's condition don't involve a high-tech test or scan, but rather human interaction with the patient. This is why emergency room doctors normally take the time to interview patients to obtain a broader picture of their health condition.

The authors suggest facial expression analysis could be yet another tool to help ER doctors evaluate patients and prioritize treatment, though more research would need to be conducted on the topic.

"If these components could be made transparent and quantifiable, this could translate into important information in terms of education of emergency care providers, and development of more accurate and natural methods of pretest probability assessment for serious diseases," the authors write in their study.

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