Miller Andrew C, Frei Steven P, Rupp Valerie A, Joho Brian S, Miller Kerry M, Bond William F
Lehigh Valley Hospital and Health Network, JDMCC Suite #212, Allentown, PA 18105-1556, USA.
J Am Osteopath Assoc. 2012 Aug;112(8):502-8.
The process of medical clearance screening for patients with psychiatric chief complaints has not been standardized.
To investigate the validity of a triage algorithm for psychiatric screening (TAPS) as a method to screen for the absence of acute medical illness in these patients.
The current study was a structured, retrospective medical record review in a suburban community teaching hospital with 37,000 emergency department visits per year. All ambulatory patients presenting to triage with a psychiatric chief complaint from January 31, 2001, to June 21, 2002, were assessed with TAPS. Patients with a completed TAPS and a negative assessment were identified and included in the study. A negative TAPS assessment comprised age younger than 65 years, normal vital signs, no medical complaints, no evidence of recent substance use, and no history of schizophrenia, mental retardation, or hallucinations. Emergency department records, return visit records, and inpatient admission records were reviewed for the diagnosis or management of acute medical illness.
A total of 1179 patients were assessed with TAPS, of whom 825 (70%) had negative TAPS assessment and were eligible for inclusion. A random sample of 100 patients was selected from this group, with 7 exclusions. Sixty-six (71%) had a history of mental illness and 51 (55%) were admitted. Further, 25 (27%) had laboratory tests ordered, and none of the laboratory results required medical intervention. Twenty-nine patients (31%) received medication, mostly previously prescribed medications or sleep aids. None of the medications were for treating patients with violent or aggressive behavior. The average length of stay was 409 minutes. No patients (95% confidence interval, 0%-3%; P<.05) received a diagnosis of or treatment for acute medical illness.
The TAPS form is potentially an effective tool in screening for the absence of acute medical illness.
以精神科主诉就诊患者的医疗检查流程尚未标准化。
探讨精神科筛查分诊算法（TAPS）作为筛查这些患者是否存在急性内科疾病方法的有效性。
本研究是在一家每年有37000例急诊科就诊患者的郊区社区教学医院进行的结构化回顾性病历审查。对2001年1月31日至2002年6月21日期间以精神科主诉前来分诊的所有门诊患者进行TAPS评估。确定并纳入完成TAPS且评估结果为阴性的患者。TAPS阴性评估包括年龄小于65岁、生命体征正常、无内科主诉、无近期药物使用证据、无精神分裂症、智力障碍或幻觉病史。审查急诊科记录、复诊记录和住院入院记录以了解急性内科疾病的诊断或治疗情况。
共有1179例患者接受了TAPS评估，其中825例（70%）TAPS评估为阴性，符合纳入标准。从该组中随机抽取100例患者，排除7例。66例（71%）有精神疾病史，51例（55%）入院。此外，25例（27%）进行了实验室检查，所有实验室结果均无需医疗干预。29例患者（31%）接受了药物治疗，主要是先前开具的药物或助眠药物。没有药物用于治疗暴力或攻击性行为患者。平均住院时间为409分钟。没有患者（95%置信区间，0%-3%；P<0.05）被诊断为急性内科疾病或接受急性内科疾病治疗。
TAPS表格可能是筛查是否存在急性内科疾病的有效工具。
