MEDICAL CLEARANCE AND SCREENING OF PSYCHIATRIC-PATIENTS IN THE EMERGENCY DEPARTMENT

Objectives: To study the frequency of medical complaints and need for routine ED medical, laboratory, and toxicologic clearance for patients presenting with psychiatric chief complaints. Methods: A retrospectiv e, observational analysis of psychiatric patients seen in an urban tea ching hospital ED over a 2-month period was performed, The individual sensitivities of history, physical examination, vital signs, and compl ete blood counts and chemistry panels for identifying medical problems were determined. The sensitivities and predictive values of patient s elf-reporting of recent illicit drug and ethanol use were also determi ned. Results: 352 patients were seen with psychiatric chief complaints . A complete data set was available for 345 patients (98%). Of those w ith complete data, 65 (19%) had medical problems of any type. History, physical examination, vital signs, and laboratory testing had sensiti vities of 94%, 51%, 17%, and 20%, respectively, for identifying these medical problems. Screening without universal laboratory testing would have missed 2 asymptomatic patients with mild hypokalemia. Patient se lf-reporting had a 92% sensitivity, a 91% specificity, an 88% positive predictive value (PPV), and a 94% negative predictive value (NPV) for identifying those with a positive drug screen, and a 96% sensitivity, an 87% specificity,a 73% PPV, and a 98% NPV for identifying those wit h a positive ethanol level. Conclusion: The vast majority of medical p roblems and substance abuse in ED psychiatric patients can be identifi ed by initial vital signs and a basic history and physical examination . Universal laboratory and toxicologic screening of all patients with psychiatric complaints is of low yield.