Kagel Karyn E, Smith Meghan, Latyshenko Ilya V, Mitchell Christopher, Kagel Andrew
Department of Emergency Medicine, Carl R. Darnall Army Medical Center, Fort Hood, Texas.
US Army Med Dep J. 2017 Jul-Sep(2-17):18-24.
To determine whether mandatory psychiatric admission laboratory tests yield results that change the disposition of a patient with primary psychiatric complaint from admission to a psychiatric service to admission to a medical service.
This was a single center retrospective cohort chart review study approved by the facility Institutional Review Board in which we used a records database maintained by the emergency department's social workers to access the records of every patient that presented to our emergency department with a psychiatric chief complaint between the dates of December 1, 2011, and December 1, 2013. We focused on those that were admitted to either a psychiatric service or a medical service after a thorough evaluation by the department of social work and an emergency provider. We applied our inclusion and exclusion criteria and reviewed the results of the mandatory psychiatric laboratory tests (complete blood count, comprehensive metabolic panel, thyroid stimulating hormone, acetaminophen, aspirin, blood alcohol level, urinalysis, urine pregnancy test, urine drug screen) required for admission. Our independent variables were the compulsory psychiatric admission laboratory tests and our dependent variable was the admission to a medical service.
Of 5,606 laboratory tests that were ordered and produced results for the 682 patients enrolled in our study, 51 results were considered clinically significant abnormal results, or results requiring treatment prior to psychiatric service admission, by the 2 reviewing emergency physicians. Only one of 682 psychiatric patients received a final disposition to a medical service based upon abnormal laboratory studies. That patient presented without any medical complaints but a chief complaint of "suicidal ideation," and was found to have diabetic ketoacidosis. Based on our data, the probability that an abnormal laboratory test will result in a change in disposition is 1/682=0.1% (95% CI: 0.0% to 0.9%).
Patients presenting to the emergency department with a psychiatric chief complaint and no physical complaints, abnormal vital signs, or abnormal physical exam findings have less than 1% probability that an abnormal laboratory study will change their disposition from a psychiatric admission to a medical admission.
确定强制性精神科入院实验室检查的结果是否会改变以原发性精神科主诉入院的患者从入住精神科服务机构转为入住医疗服务机构的处置情况。
这是一项经机构审查委员会批准的单中心回顾性队列图表审查研究，我们使用急诊科社会工作者维护的记录数据库，获取2011年12月1日至2013年12月1日期间因精神科主诉到我们急诊科就诊的每位患者的记录。我们关注那些在社会工作部门和急诊医疗人员进行全面评估后被收治到精神科服务机构或医疗服务机构的患者。我们应用纳入和排除标准，并审查了入院所需的强制性精神科实验室检查结果（全血细胞计数、综合代谢指标、促甲状腺激素、对乙酰氨基酚、阿司匹林、血液酒精水平、尿液分析、尿液妊娠试验、尿液药物筛查）。我们的自变量是强制性精神科入院实验室检查，因变量是入住医疗服务机构。
在为我们研究中纳入的682名患者所开具并产生结果的5606项实验室检查中，2名参与审查的急诊医生认为51项结果为具有临床意义的异常结果，或为精神科服务入院前需要治疗的结果。682名精神科患者中只有1名因实验室检查异常而最终被处置到医疗服务机构。该患者就诊时无任何医疗主诉，主要主诉为“自杀意念”，被发现患有糖尿病酮症酸中毒。根据我们的数据，实验室检查异常导致处置改变的概率为1/682 = 0.1%（95%可信区间：0.0%至0.9%）。
因精神科主诉到急诊科就诊且无身体主诉、生命体征异常或体格检查异常发现的患者，实验室检查异常将其处置从精神科入院转为医疗入院的概率小于1%。
