History-taking Acronym
Author: Georgina Tiarks, MD
Editor: Alyssa Haag, MD
Editor: Ian Mannarino, MD, MBA
Editor: Kelsey LaFayette, DNP, ARNP, FNP-C
Illustrator: Jannat Day
Modified: Jan 06, 2025
What is history of present illness?
The history of present illness (HPI) is a vital portion of the medical examination dedicated to gathering information on what has brought the patient to the medical center, or their chief complaint. A healthcare provider will ask relevant questions about the history of presenting complaints to elicit enough information so that they may determine a potential diagnosis and plan. For example, if an individual comes in complaining of chest pain, it is important to ask specific questions relevant to the chest pain to ascertain the underlying cause, like if the individual has a history of cardiovascular disease or chest pain that improves with rest. This may guide the clinician to consider serious causes of chest pain, such as a myocardial infarction (i.e., heart attack) or angina (i.e., chest pain related to heart disease) as an underlying cause. Once the history of present illness portion of the exam is complete, a healthcare provider may also ask a review of systems (i.e., additional broad review of other symptoms that may be occurring), and whether they have a history of other medical problems, allergies, current medications, family history, surgical history, and social history. A social history describes important information about where they live, their job, eating habits, tobacco use, drug use, and sexual history. 
What is COLDSPA?
COLDSPA is an acronym that helps healthcare professionals remember important questions when discussing the patient’s history of present illness. What does the “C” in COLDSPA mean?
The “C” refers to the character of the individual’s symptom or pain. They may use words such as stabbing, burning, throbbing, sharp, dull, or crushing to describe what their pain feels like. Or, if they are experiencing a symptom such as dizziness, they may use adjectives such as spinning, unsteadiness, or lightheadedness. What does the “O” in COLDSPA mean?
The “O” refers to the onset of the current problem. One may ask the patient when the symptom began and what they were doing when the problem first occurred.
What does the “L” in COLDSPA mean?
The “L” signifies the location of the complaint. An individual may tell you their pain or symptom is located somewhere specific on their body. One may also ask if the pain radiates, or moves, to other part of the body. What does the “D” in COLDSPA mean?
The “D” stands for duration. How long has the problem been going on? How long does the symptom last? Does the symptom come and go or is it constant? This can help determine the timing of the symptom, whether it is constant, waxing and waning (i.e., always there but gets better and worse), or intermittent.
What does the “S” in COLDSPA mean?
The “S” stands for severity. For this question, one may want to ask the person to rate their pain or symptom on a scale of 0 to 10. The lower the rating, the less pain they are experiencing. Conversely, a 10/10 pain would be referring to excruciating pain. Additionally, this can help one determine whether the symptom is mild, moderate, or severe.
What does the “P” in COLDSPA mean?
The “P” refers to the pattern of the pain or symptom. One could ask questions such as, “What makes it better?” and “What makes it worse?” It may also be useful to deduce whether they’ve tried any treatment options thus far (e.g., medications, positioning, applying cold or hot compresses) and the response to the treatment.
What does the “A” in COLDSPA mean?
The “A” stands for associated factors. This refers to any other question related to their symptom such as whether they have any other associated symptoms or if they have a suspicion of what caused or causes it.
What are the most important facts to know about the COLDSPA acronym?
The COLDSPA acronym can be a useful tool to guide healthcare providers when they ask questions about the history of present illness. When an individual presents with a problem, it is important to ask relevant, specific questions that can help to determine what the underlying cause is. The “C” refers to the character or description of the symptom. “O” refers to the onset of the symptom. The “L” stands for the location of the symptom, while the “D” stands for the duration of the problem. “S” stands for severity, which is typically rated on a scale of 1-10. “P” refers to the pattern of the symptom. Lastly, the “A” stands for any additional associating factors that could be related to the problem. 
