Brouillard Daniel, Melville Geoffrey, Lam Mary K, Woods Jessie, Martoo James, Wilkie Gabrielle, Makoni Hughes, Rahman Ataur, Odigboh Emezie, Carrigan Thomas, Binks Simon, Fielding Naomi, Curtis Kate
Emergency Department, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Warrawong, New South Wales, Australia.
School of Health and Biomedical Sciences, STEM college, RMIT University, Melbourne, Victoria, Australia.
Emerg Med Australas. 2025 Feb;37(1):e14516. doi: 10.1111/1742-6723.14516. Epub 2024 Oct 25.
To evaluate the use and impact of pathology tests in patients who present to the ED with mental health-related complaints. The primary objective is to measure the proportion of patients undergoing pathology tests and assess whether these tests trigger a change in management.
In this retrospective study, we reviewed all recorded mental health presentations to our regional ED between January and June 2021. Patient characteristics, pathology tests, subsequent change in management, treatment costs and time to Emergency Physician and Psychiatrist were extracted. Descriptive statistics and multivariate analysis were used to explore associations between variables of interest, ED length of stay (LOS) and change in management.
Of 37 900 ED visits, 1462 (3.9%) were mental health-related presentations. Pathology tests were conducted in 47.7% of cases, with 3% leading to a change in management. Pathology tests were associated with increased treatment costs (45% increase for blood tests, 17% for urine), and increased ED LOS (48%). Patients with coexisting medical conditions were three times more likely to have a change in management.
Pathology tests should be reserved for patients with high-risk features and based on clinical assessment. Strategic use of pathology tests could avoid unnecessary delays and costs, enhancing patient care in mental health-related ED presentations.
评估针对因心理健康相关主诉就诊于急诊科的患者进行病理检查的应用情况及其影响。主要目的是测量接受病理检查的患者比例，并评估这些检查是否引发了管理上的改变。
在这项回顾性研究中，我们回顾了2021年1月至6月间我们地区急诊科所有记录的心理健康相关就诊情况。提取了患者特征、病理检查、后续管理上的改变、治疗费用以及到急诊医生和精神科医生处就诊的时间。采用描述性统计和多变量分析来探讨感兴趣的变量、急诊科住院时间（LOS）和管理改变之间的关联。
在37900次急诊科就诊中，1462次（3.9%）是与心理健康相关的就诊。47.7%的病例进行了病理检查，其中3%导致了管理上的改变。病理检查与治疗费用增加相关（血液检查增加45%，尿液检查增加17%），且急诊科住院时间增加（48%）。患有并存疾病的患者管理上发生改变的可能性高出三倍。
病理检查应仅用于具有高风险特征的患者，并基于临床评估。合理使用病理检查可以避免不必要的延误和费用，改善心理健康相关急诊科就诊患者的护理。
