July 17, 2014 by dailybolusoflr
We are not going to address the assessment of psychiatric risk which is a different ball game. We are going to briefly address “medical screening”
What is the purpose of medical screening?
To conduct a focused medical assessment to achieve 2 goals:
2) To detect and treat any illness and/or injury in need of acute care
Why is medical screening necessary?
To identify serious medical conditions that may be masquerading as psychiatric disorders for example:
- Traumatic brain injury
- Cerebrovascular disease
- Neuroendocrine abnormalities
Most articles emphasize an adequate history and physical exam (including vital signs) and cognitive examination, with a minimum of evaluating for orientation as the most important components of medical screening exam.
Studies have found that testing for orientation had a higher yield of clinically significant findings than any other screening procedure and that disorientation can be an indicator of serious underlying medical conditions in psychiatric patients.
Instead of routine laboratory testing, the data supports more selective testing for patients at high risk of serious medical pathology:
2) preexisting medical conditions or medical complaints
3) substance abuse disorders
4) new onset of psychiatric symptoms
5) low socioeconomic status
Gregory RJ, Nihalani ND, Rodriguez E. Medical screening in the emergency department for psychiatric admissions: a procedural analysis. General Hospital Psychiatry. 2004;26:405-410.
American College of Emergency Physicians Clinical Policies Subcommittee. Clinical Policy: Critical issues in the diagnosis and management of the adult psychiatric patient the emergency department. Ann Emerg Med. 2006;47:79-99.