Patients who cannot make expressions could be suffering from serious heart and lung disease.
People who cannot express their surprise could be suffering from serious heart and lung disease.
The study found patients with serious heart and lung conditions don’t have the normal range of facial expressions, particularly the ability to register surprise in response to emotional cues.
Patients with chest pain and shortness of breath who had a potentially serious heart or lung condition had a significantly narrower range of facial expression than other patients, research revealed.
The lack of facial expressions could help casualty doctors prioritise patients and adds scientific credibility to the rapid visual assessment doctors make of how sick someone is, formally known as gestalt pretest probability.
The preliminary research published online in Emergency Medicine Journal tested the diagnostic accuracy of reduced facial expression range in 50 adults with shortness of breath (dyspnoea) and chest pain in an A&E department.
The patients briefly viewed a humorous cartoon, a close-up of a surprised face, and a picture of someone in tears designed to evoke an emotional response on a laptop and their response recorded.
These were then analysed using the Facial Action Coding System (FACS) which scores changes in facial muscle activity, reflecting the extent of smiling, frowning, and surprise.
The patients were scanned to check for serious heart or lung disease, including heart attack, unstable angina, a blood clot in the lung, pneumonia, problems in the major artery or gut, and new cancers over a fortnight.
During the monitoring period, eight – 16 per cent – patients developed serious heart or lung disease.
Among the 42 considered not to have any serious health problem, two developed worsening chronic obstructive pulmonary disease, two developed heart failure; and one an irregular heart rhythm.
The analysis of the webcam recordings showed that patients with chest pain and shortness of breath who had a potentially serious heart or lung condition had a significantly narrower range of facial expression in response to visual cues than those who did not have these health problems. The difference in the ability to express surprise most strongly demarcated those with serious heart and lung problems from those without.
Dr Jeffrey Kline at the Department of Emergency Medicine, Indiana University School of Medicine said: ‘We believe that due to the gravity of their illness, these patients may not have been able to process and respond to an emotional stimulus in the way that would be expected of most people under normal conditions
‘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 scanning, which could be added to the physical examination.’
