When patients show up to the ER with psychiatric complaints, how doctors screen them for underlying medical conditions varies widely — and a new review confirms the evidence guiding those decisions is pretty thin. A scoping review of 145 studies found that most research is retrospective and inconsistent, making it hard to pin down which screening tools actually work. Experts still recommend leading with history, vitals, and physical exam — just don't expect robust data to back that up.
When a patient walks into the emergency department with a psychiatric complaint, figuring out whether there's an underlying medical cause is critical — but how clinicians approach that workup is highly variable. A new scoping review of 145 studies published in Annals of Emergency Medicine found that medical screening practices for these patients are inconsistent and supported by weak, mostly retrospective evidence.
Researchers categorized screening into eight areas: lab testing, history taking, vital signs, physical exam, imaging, screening tools, ECG, and system-level factors. Lab testing was the most studied (63% of original studies), but routine urine drug screening — one of the most commonly ordered tests — didn't change ED management or patient disposition in any of the studies that examined it.
Key Takeaways:
Why it matters: With a large volume of psychiatric visits to EDs each year, inconsistent and evidence-poor screening practices can lead to missed diagnoses, unnecessary testing, or delayed care. This review highlights the urgent need for better-designed prospective studies to build a stronger evidence base.
