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Variations in Medical Clearance Testing for Mental Health Emergency Department Visits.

Chris A Rees1, Matt Hall2, Sriram Ramgopal3

  • 1Division of Pediatric Emergency Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.

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|September 9, 2025
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Summary

Routine medical clearance testing for pediatric mental health emergencies is common, varying widely by hospital and incurring significant costs. These practices may be unnecessary, impacting healthcare spending.

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Area of Science:

  • Pediatric Emergency Medicine
  • Child and Adolescent Psychiatry
  • Health Services Research

Background:

  • Recommendations advise against routine medical clearance testing for children in emergency departments (EDs) presenting with mental health concerns.
  • However, the actual practices, influencing factors, and associated costs remain incompletely understood.

Purpose of the Study:

  • To investigate the variation, patient and hospital factors, and costs related to medical clearance testing in pediatric ED encounters for mental health concerns.

Main Methods:

  • A cross-sectional study analyzed ED encounters for children aged 5-18 years across 35 US children's hospitals from 2016-2023.
  • Medical clearance testing was defined by the performance of specific laboratory and diagnostic tests.
  • Generalized estimating equations identified factors associated with testing, and costs were estimated from billed charges.

Main Results:

  • Over half (56.9%) of the 604,869 analyzed ED encounters included at least one medical clearance test.
  • Significant hospital-level variation in testing prevalence was observed (33.5% to 85.3%).
  • Testing was more likely for patients admitted to psychiatric units or transferred to psychiatric facilities, with total annual costs reaching $25,187,999.

Conclusions:

  • Medical clearance testing is frequently performed in pediatric ED mental health encounters, despite existing recommendations against it.
  • Practices vary considerably across hospitals, suggesting a lack of standardized care.
  • These tests represent a substantial financial burden, potentially indicating unnecessary healthcare expenditure.