TOPLINE

A scoping review of 145 studies found that evidence supporting medical screening practices for adults presenting to the emergency department (ED) with psychiatric complaints was limited, heterogeneous, and largely based on retrospective studies, making it insufficient to establish the diagnostic accuracy of commonly used screening approaches.

METHODOLOGY

• Researchers conducted a scoping review of 145 studies that evaluated medical screening practices for adults aged 18 years or older who presented to general EDs with psychiatric complaints.
• Overall, 62 original research articles, 74 nonoriginal publications, and nine society recommendations were included. Original studies comprised 34,836 patients and 1149 healthcare professionals.
• Researchers categorized medical screening practices into eight themes: laboratory testing, history taking, vital sign assessment, physical examination, diagnostic imaging, medical screening tools, electrocardiography, and system-level factors.
• Researchers assessed adherence to medical screening strategies and the association between these screening strategies and changes in management or patient outcomes, with a primary focus on the diagnostic accuracy and performance characteristics of these screening practices.

TAKEAWAY

• Laboratory testing was the most frequently studied medical screening practice, appearing in 39 of 62 original studies (62.9%), followed by history taking (35.5%), vital signs (33.9%), and physical examination (30.6%).
• Among studies examining laboratory testing, routine urine drug screening did not change ED management or disposition in any patients across four retrospective cross-sectional studies and two prospective observational studies.
• Vital signs were assessed in 21 studies, but evidence for their diagnostic accuracy remained limited. However, abnormal vital signs, particularly an abnormal heart rate (odds ratio [OR], 8.48; 95% CI, 3.90-28.42) and fever (OR, 9.82; 95% CI, 3.91-18.40), were linked to a higher likelihood of an underlying medical condition.
• Physical examination identified a medical condition contributing to psychiatric symptoms and led to changes in diagnosis or management in about 15% of patients. In one study, the Shah Score showed low sensitivity for identifying patients who did not require further medical workup.

IN PRACTICE

"At this time, multiple society recommendations have emphasized that medical screening should be guided primarily by history, vital signs, and physical examination, although these recommendations are not based on rigorously conducted studies," the authors wrote.

SOURCE

The study was led by Luca Ünlü, MD, University Hospital Basel, Basel, Switzerland. It was published online on June 2, 2026, in Annals of Emergency Medicine.

LIMITATIONS

This review was limited by the possibility that relevant studies were missed because of the search strategy, the predominance of retrospective studies that limited reliable assessment of diagnostic performance, the inability to assess the risk for bias or certainty of evidence because of the scoping review design, and limited global generalizability because most studies originated from the United States and other high-income countries.

DISCLOSURES

The study received support from scientific funds of the Emergency Department of the University Hospital Basel. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.