Accuracy of diagnosis at routine psychiatric assessment in patients presenting to an accident and emergency department.
OBJECTIVE
This study aimed to compare diagnoses obtained from routine psychiatric assessment in accident and emergency (A&E) settings with those from a standardized diagnostic interview.


METHODS
Using Cohen's kappa, the agreement between diagnoses from routine psychiatric assessment and structured interview was calculated. Further statistical analysis was used to investigate differences between some of the main diagnostic subgroups.


RESULTS
The overall kappa value for all diagnoses was .47. Adjustment disorder, major depressive disorder and alcohol misuse/dependence were commonly identified, both at routine assessment and on structured interview. There was a disparity between the two diagnostic systems in the extent to which major depressive disorder and adjustment disorder were identified. Further analysis between these two groups was inconclusive as to the reasons for this difference.


CONCLUSIONS
There was moderate agreement between clinical and standardized diagnoses. Anxiety disorders were poorly identified at routine assessment. There is difficulty distinguishing between adjustment disorder and depressive episode in the A&E setting.
Taggart
Catherine
C
Department of Psychiatry, Belfast City Hospital, Belfast, BT9 7AB, Ireland.
O'Grady
John
J
Stevenson
Mike
M
Hand
Elaine
E
Mc Clelland
Roy
R
Kelly
Chris
C
D000275:Adjustment Disorders / Q000175:diagnosis* / Q000523:psychology; D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000523:psychology; D003710:Demography; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000523:psychology; D003937:Diagnosis, Differential; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D016728:Self-Injurious Behavior / Q000175:diagnosis* / Q000523:psychology; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000523:psychology