Icahn School of Medicine at Mount Sinai New York, New York, United States
Background: Children often experience acute mental health issues requiring inpatient counseling and therapy. It is often recommended to perform a battery of screening medical tests on those who are admitted for psychiatric inpatient management.
Objective: To determine the efficacy and cost of performing a standard battery of ED screening tests used to identify an occult medical issue prior to psychiatric inpatient admission of children who present to the emergency department with acute mental health emergencies.
Design/Methods: Review of consecutive pediatric ED cases of children with acute mental health emergencies requiring inpatient admission to a psychiatric unit during a 4-year period. A standing protocol endorsed that all patients receive performance of a medical history and physical examination; if negative for an otherwise acute medical issue, and psychiatric evaluation deemed inpatient care was indicated, a standard battery of [up to] 9 pre-admission screening medical tests was performed, including: complete blood count [CBC], basic metabolic panel [BMP], thyroid stimulating hormone [TSH], rapid plasma reagent [RPR], hepatic function panel; urinalysis [U/A], urine qualitative toxicology panel [U-tox], urine pregnancy test [UPT for menstruating females]; and 12-lead EKG.
Results: A total of 579 consecutive cases with an acute psychiatric condition were evaluated in the pediatric ED. Four patients were admitted to the medicine unit [all were intentional toxic ingestions identified by history]; the other 575 consecutive cases were admitted to the inpatient psychiatric ward, comprising the study group. There were 4,223 screening medical tests performed, with only 2.6% classified as abnormal, and 0.3% prompting a change in management [further lab testing]; no abnormality was associated with in-hospital subspecialist consultation or change in disposition. The total cost for performing these tests was $620,115; the calculated average cost per patient was $1,078.Conclusion(s): Performing routine medical screening tests for all children with acute psychiatric emergencies requiring admission to an inpatient psychiatric unit is not effective in identifying occult medical conditions requiring management intervention or disposition alteration; and results in significant health care cost expenditure. Efficacy of ED screening tests for children admitted to an inpatient psychiatric unit for acute mental health emergencies Table
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