Prospective evaluation of emergency department medical clearance.
OBJECTIVE
To analyze a standardized medical evaluation of alert, adult emergency department patients with new psychiatric symptoms.


METHODS
Prospective, descriptive case series.


METHODS
Urban, county hospital.


METHODS
One hundred consecutive, alert patients, aged 16 to 65 years, seen over 9 months, with new psychiatric symptoms. Excluded patients included those with obvious alcohol or drug intoxication, psychiatric patients with previously diagnosed abnormal behavior, psychiatric patients with medical complaints, and overdose or suicide patients.


METHODS
The following evaluation was performed: medical history, physical examination, complete blood count, SMA-7 (electrolytes, blood urea nitrogen, creatinine, and glucose), prothrombin time, calcium, oxygen saturation, creatine phosphokinase (CPK) if there was possible myoglobulinuria, alcohol level, urine drug screen (for cocaine, amphetamine, and phencyclidine), cranial computed tomography, lumbar puncture if febrile, and psychiatric evaluation when appropriate. Results were considered significant when they diagnosed the cause of the symptoms or resulted in medical admission.


RESULTS
Sixty-three of the 100 patients had an organic etiology of their symptoms. The medical history was significant in 27, physical examination in 6, CBC in 5, SMA-7 in 10, CPK in 6, alcohol and drug screen in 28, computed tomography scan in 8, and lumbar puncture in 3.


CONCLUSIONS
Most alert, adult patients with new psychiatric symptoms have an organic etiology. We recommend performing a medical history, physical examination, SMA-7, calcium, CPK if there is possible myoglobinuria, alcohol and drug screens, computed tomography scan, and lumbar puncture as part of the medical clearance of these patients.
Henneman
P L
PL
Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance.
Mendoza
R
R
Lewis
R J
RJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D001772:Blood Cell Count; D001774:Blood Chemical Analysis; D004637:Emergency Services, Psychiatric; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking; D001523:Mental Disorders / Q000150:complications* / Q000175:diagnosis; D008875:Middle Aged; D019965:Neurocognitive Disorders / Q000175:diagnosis; D010343:Patient Admission; D010360:Patient Transfer; D010808:Physical Examination; D011446:Prospective Studies