Comprehensive Review of Systems

General Components

A comprehensive review of systems should include a systematic assessment of symptoms across all major body systems to identify potential health concerns that may not have been captured in the chief complaint or history of present illness 1
The review of systems should be comprehensive and include questioning about common symptoms related to each body system, including fever, night sweats, weight loss, headaches, visual changes, oral issues, respiratory symptoms, chest pain, gastrointestinal symptoms, urinary symptoms, skin problems, neurological changes, and mental status changes 1
For women, a menstrual history should be obtained as part of the review of systems 1
Current weight should be compared with baseline, along with a dietary assessment 1

Unexplained weight loss, night sweats, fever, changes in body habitus should be assessed in the general system review 1
Skin discoloration, rash, ulcers, or lesions should be assessed in the skin system review 1
Localized or generalized enlargement of lymph nodes should be assessed in the head and neck review 1
Visual changes or disturbances should be assessed in the eyes review 1
Oral thrush or ulceration, swallowing difficulties should be assessed in the ears, nose, and throat review 1
Cough, shortness of breath, wheezing, chest pain should be assessed in the respiratory system review 1
Chest pain, palpitations, orthopnea, edema should be assessed in the cardiovascular system review 1
Nausea, vomiting, abdominal pain, diarrhea, changes in bowel habits should be assessed in the gastrointestinal system review 1
Urinary symptoms including frequency, urgency, dysuria should be assessed in the genitourinary system review 1
Joint pain, stiffness, swelling, muscle weakness should be assessed in the musculoskeletal system review 2
Changes in neurological function or mental status should be assessed in the neurological system review 1
Depression screening should be performed as part of the psychiatric assessment 1

For patients with suspected neurological disorders, include assessment of timed gait, motor movements, reflexes, and Babinski signs 3
For diabetic patients, include comprehensive foot examination with inspection of skin integrity, assessment of foot deformities, neurological assessment, and vascular assessment 3
For elderly patients, include assessment of functional and cognitive performance, frailty, fall risk, and need for assistive devices 2
For patients with cardiovascular concerns, include assessment of volume status, jugular venous pressure, and presence of peripheral edema 4
For patients with acute limb ischemia, the review of systems should focus on uncovering clinical evidence of conditions that can result in ALI, including atrial fibrillation, myocardial infarction, cardiomyopathy, valvular heart disease, aortic disease, and hypercoagulable states 6

A comprehensive review of systems helps identify symptoms not mentioned in the chief complaint that may be relevant to diagnosis and treatment 2
The review of systems is an essential component of the primary evaluation phase for patients with fatigue and can help determine various organ systems affected 5
A thorough review of systems can guide the physical evaluation and diagnostic workup 5
The American College of Cardiology recommends a focused review of systems for patients with acute limb ischemia to identify underlying conditions 6