Gutterman E M
Rutgers University School of Social Work, New Brunswick, NJ, USA.
J Am Acad Child Adolesc Psychiatry. 1998 Oct;37(10):1030-7; discussion 1038-40. doi: 10.1097/00004583-199810000-00012.
This study tests the assumption that psychiatric diagnosis facilitates clinical evaluations of need in emergency care before and after controlling for danger.
The data are from structured crisis assessments completed by emergency clinicians in four ethnically diverse locales (N = 653). Clinician-assigned diagnosis was categorized as adjustment, disruptive, mood, psychotic, and other, and a Danger scale score reflected danger to self or others.
Mood and psychotic disorders significantly increased hospital rates in multivariate analyses which controlled for demographic characteristics, site, and danger when relevant. The model with the best fit included both diagnosis and danger.
Decisions should be linked to verifiable ratings of need and attention to danger, and its measurement should complement the current focus on diagnosis.
本研究检验了这样一种假设，即在控制危险因素前后，精神科诊断有助于急诊护理中对需求的临床评估。
数据来自四个不同种族地区的急诊临床医生完成的结构化危机评估（N = 653）。临床医生指定的诊断分为适应障碍、破坏性行为障碍、情绪障碍、精神病性障碍及其他，危险量表得分反映对自身或他人的危险程度。
在多变量分析中，情绪障碍和精神病性障碍显著增加了住院率，该分析在相关情况下控制了人口统计学特征、地点和危险因素。拟合度最佳的模型同时包含诊断和危险因素。
决策应与可验证的需求评级以及对危险的关注相联系，并且危险的测量应补充当前对诊断的关注。
