- Design
- Scoping review
- Population
- 145 publications, including 62 studies of 34,836 patients
- Primary outcome
- Medical screening practices for adult psychiatric ED presentations
- Effect
- 8 themes; most society statements discourage routine laboratory tests
A scoping review in Annals of Emergency Medicine (June 2026) mapped 145 publications on medical screening of adults presenting to general emergency departments with psychiatric complaints, including 62 original studies (34,836 patients) and 9 society recommendations.
Studies grouped into eight themes, most often laboratory testing, history, vital signs and examination. Most were retrospective. Most society recommendations discouraged routine laboratory testing and called for joint emergency-psychiatry protocols; none fully met standards for trustworthy guideline development.
The review does not show which screening approach is safest — the evidence to answer that does not exist. But it supports a targeted approach: history, vital signs and examination first, with tests chosen by what they find.
- Take a history, check vital signs and examine every psychiatric presentation before transfer
- Order tests based on findings, age, substance use and new symptoms, not as a routine panel
- Look harder for a medical cause in first presentations, older patients and abnormal vital signs
- Agree a joint screening protocol with the local psychiatry service
Why it matters
Routine 'clearance' panels delay psychiatric care without clear evidence that they find what history and examination miss.
Don't overread it
The underlying studies are mostly retrospective; the review cannot say which screening strategy is safest.
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