Surprise! Lack of facial expressions could indicate disease

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A study has found that patients who suffer with serious lung and heart conditions are unable to fulfil the normal range of facial expressions, particularly those in response to emotional cues.

The study has revealed that patients who suffer from shortness of breath and chest pain, who may have a potentially serious lung or heart condition, had a more limited range of facial expressions than other patients.

This lack of expression could aid casualty doctors in their assessment of the level of illness of patients and prioritise them effectively. This used to be known as gestalt pretest probability.

The initial research included tests of diagnostic accuracy of 50 adults with chest pain and shortness of breath in an A&E department, by using their facial expressions.

The patients were requested to view a humorous cartoon for a short period, a picture of a person crying and a close-up of a surprised face on a laptop, in a bid to evoke an emotional response.

Their responses were recorded and later analysed using the Facial Action Coding System (FACS) which uses a system of scoring based on facial muscle activity, which indicates the extent of surprise, frowning and smiling.

The patients underwent assessments for lung or heart disease, including new cancers, problems in the gut or major arteries, blood clots in the lungs, heart attack and unstable angina, over a period of two weeks. During this time period, eight or 16% of patients developed serious lung or heart disease. Among the 42 who were considered not to have serious health issues, two developed chronic obstructive pulmonary disease, two suffered from heart failure and one suffered from an irregular heartbeat.

The analysis done on the webcam recordings indicated that those patients suffering from shortness of breath and chest pain and who had a potentially serious lung or heart condition, indicated a much narrower facial expression range to visual prompts than the ones who did not have these health issues.

The variance in being able to express surprise separated those with serious lung and heart problems from those without these health problems.

Dr Jeffrey Kline from the Department of Emergency Medicine, at Indiana University School of Medicine, stated that they are of the opinion that the seriousness of their illness may have had an effect on the processing and response to the emotional cues of the patients and this may be the reason for the lack of facial expressions.

He said that the main goal of this study is to offer clinicians a new method of linking patients to certain illnesses during physical examinations, in a bid to avoid unnecessary scanning.

Image Credit: J.K. Califf

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