Garbrick L, Levitt M A, Barrett M, Graham L
Alameda County Medical Center, Department of Emergency Medicine, Oakland, CA 94601, USA.
Acad Emerg Med. 1996 Nov;3(11):1027-30. doi: 10.1111/j.1553-2712.1996.tb03348.x.
To determine the level of agreement between emergency physicians (EPs) and psychiatrists regarding the need for acute psychiatric hospitalization and treatment for patients presenting with alleged psychiatric complaints.
A prospective, cross-sectional assessment of concordance between EPs and psychiatrists in psychiatric admission decisions was performed at an urban county, teaching hospital ED. The participants had been brought to the ED for psychiatric evaluation. The patients were interviewed by an attending EP or a senior-level resident, and a tentative impression and disposition were determined prior to an independent examination and final disposition by a psychiatrist. Strength of physician group agreement was determined using the kappa statistic.
The patient mean age was 37.5 +/- 15 years; 51% were men. The most common reasons for evaluation were disruptive behavior (28%), overdose (24%), and danger to self (23%). Of the 156 patients, 47 (28.7%) were sent home without treatment, 10 (6.3%) were determined to need only medical treatment, and 6 (3.7%) were released with outpatient psychiatric treatment. There were 84 (55.7%) patients admitted for psychiatric treatment. The EPs and psychiatrists had only moderate agreement regarding danger to self (kappa = 0.44), danger to others (kappa = 0.40), substance abuse as the primary problem (kappa = 0.50), and need for psychiatric hospitalization (kappa = 0.54).
Moderate agreement between EPs and psychiatrists in key impressions and admission decisions suggests that shared training in psychiatric decision making, especially during residency training, is desired in this setting.
确定急诊医生（EPs）和精神科医生在疑似有精神疾病主诉患者的急性精神科住院治疗需求方面的一致程度。
在一家城市县教学医院急诊科对急诊医生和精神科医生在精神科住院决策方面的一致性进行前瞻性横断面评估。参与者因精神科评估被送至急诊科。患者由主治急诊医生或高级住院医师进行访谈，并在精神科医生进行独立检查和最终处置之前确定初步印象和处置方式。使用kappa统计量确定医生群体的一致强度。
患者平均年龄为37.5±15岁；51%为男性。最常见的评估原因是破坏性行为（28%）、药物过量（24%）和对自身的危险（23%）。在156名患者中，47名（28.7%）未经治疗即被送回家，10名（6.3%）被确定仅需药物治疗，6名（3.7%）在接受门诊精神科治疗后出院。有84名（55.7%）患者因精神科治疗入院。急诊医生和精神科医生在对自身的危险（kappa = 0.44）、对他人的危险（kappa = 0.40）、药物滥用作为主要问题（kappa = 0.50）以及精神科住院需求（kappa = 0.54）方面仅存在中等程度的一致性。
急诊医生和精神科医生在关键印象和住院决策方面的中等程度一致性表明，在这种情况下，尤其是在住院医师培训期间，进行精神科决策的共同培训是有必要的。
