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Medical Screening of Adult Psychiatric Patients Presenting to the Emergency Department
Luca Ünlü1, Johannes A Griese2, Bruno Minotti2
1Department of Emergency Medicine University Hospital Basel, Basel Stadt, Switzerland; Department of Emergency Medicine, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.
Study Objective:
Medical screening (often termed "medical clearance") is often performed to exclude acute medical conditions in psychiatric emergency department (ED) presentations. This scoping review aims to map and appraise the currently available literature on medical screening of adult (18 years and older) patients with psychiatric complaints in the ED.
Methods:
We searched Medline, PsycInfo, EMBASE, and Web of Science from inception to April 2025, supplemented by citation searching and expert consultation. Eligible studies of any design included adult patients with psychiatric complaints presenting to general EDs and reported on medical screening practices. Key study characteristics were charted from all eligible articles. Original research articles and society statements underwent thematic analysis.
Results:
Of 9,128 records screened, 145 publications met inclusion criteria, including 62 original research articles, 74 nonoriginal publications, and 9 society recommendations. Among original research articles with primarily retrospective study design (59.7%) on 34,836 patients and 1,149 health care professionals, we identified 8 themes: laboratory testing (38, 62.9%), history taking (22 studies, 35.5%), vital signs (21, 33.9%), physical examination (19, 30.6%), diagnostic imaging (13, 21.0%), medical screening tools (10, 16.1%), electrocardiography (9, 14.5%), and system-level factors (8, 12.9%). Nonoriginal publications were tabulated. Most society recommendations discouraged routine laboratory testing of psychiatric ED presentations and called for collaboration between emergency medicine and psychiatry stakeholders. None of the society recommendations perfectly adhered to either the National Academy of Medicine recommendations for creating trustworthy guidelines or Grading of Recommendations Assessment, Development and Evaluation methodology.
Conclusions:
Medical screening practices can be categorized into 8 distinct themes, with the greatest amount of data available for laboratory testing, history taking, and vital sign assessment. Studies are predominantly retrospective and high-quality prospective assessments of the diagnostic accuracy of medical screening practices are warranted.
