Chennapan Krithika, Mullinax Samuel, Anderson Eric, Landau Mark J, Nordstrom Kimberly, Seupaul Rawle A, Wilson Michael P
Keck School of Medicine of the University of Southern California, Los Angeles, California.
University of Arkansas for Medical Sciences, Little Rock, Arkansas.
J Emerg Med. 2018 Dec;55(6):799-812. doi: 10.1016/j.jemermed.2018.09.014. Epub 2018 Oct 10.
Patients presenting to the emergency department (ED) with psychiatric complaints often require medical screening to evaluate for a medical cause of their symptoms.
We sought to evaluate the existing literature on the medical screening of psychiatric patients and establish recommendations for ideal screening practices in Western-style EDs.
PubMed, PsycINFO, and ClinicalTrials.gov were searched for clinical studies examining the medical screening of adult psychiatric patients in the ED or inappropriate referrals to psychiatry. Articles were graded using the Effective Public Health Practice Project (EPHPP) grading tool and sorted into topics. A 3-level grading algorithm used by other emergency medicine organizations was used to evaluate the strength of the evidence for each recommendation.
Sixty articles met the inclusion and exclusion criteria. Most published literature on medical screening consisted of nonrandomized studies with a high risk of bias. Some screening procedures, such as history and physical examination, were extensively recommended. Other screening procedures received mixed recommendations.
Based on available literature, physician experts developed 7 recommendations. For a patient with known psychiatric disease presenting with symptom exacerbation, medical screening should include a full medical and psychiatric history, a targeted physical examination, and a mental status examination. Urine toxicology screening and nonurine drug screen laboratory testing should not be routinely performed. Additional screening tests may be valuable for patients with new-onset psychiatric symptoms who are ≥65 years of age, are immunosuppressed, or have concomitant medical disease. However, additional studies on this topic with more rigorous methodology must be conducted to establish definitive guidelines.
因精神科主诉前往急诊科（ED）就诊的患者通常需要进行医学筛查，以评估其症状的医学原因。
我们旨在评估有关精神科患者医学筛查的现有文献，并为西式急诊科的理想筛查实践制定建议。
检索了PubMed、PsycINFO和ClinicalTrials.gov，以查找有关急诊科成年精神科患者医学筛查或不适当转诊至精神科的临床研究。使用有效公共卫生实践项目（EPHPP）分级工具对文章进行分级，并按主题分类。采用其他急诊医学组织使用的三级分级算法来评估每项建议的证据强度。
60篇文章符合纳入和排除标准。大多数关于医学筛查的已发表文献由存在高偏倚风险的非随机研究组成。一些筛查程序，如病史和体格检查，得到了广泛推荐。其他筛查程序则得到了不同的建议。
基于现有文献，医学专家制定了7项建议。对于已知精神疾病且症状加重的患者，医学筛查应包括完整的医学和精神病史、针对性的体格检查以及精神状态检查。不应常规进行尿液毒理学筛查和非尿液药物筛查实验室检测。对于年龄≥65岁、免疫功能低下或患有合并症的新发精神症状患者，额外的筛查测试可能有价值。然而，必须就此主题开展更多采用更严格方法的研究，以建立明确的指南。
