Medical Screening of Adult Psychiatric Patients Presenting to the Emergency Department

Luca Ünlü; Johannes A Griese; Bruno Minotti; Christopher R Carpenter; Christian Appenzeller-Herzog; Philipp Sterzer; Michael Christ; Navid Azad; Kimberly Nordstrom; Clare Skinner; Jelmer Alsma; Victor Stiebel; Simon Kurzhals; Ian Ward Abdalla Maia; Roland Bingisser; Michael P Wilson; Christian H Nickel

doi:10.1016/j.annemergmed.2026.04.001

Medical Screening of Adult Psychiatric Patients Presenting to the Emergency Department

Ann Emerg Med. 2026 Jun 2:S0196-0644(26)00239-8. doi: 10.1016/j.annemergmed.2026.04.001. Online ahead of print.

Authors

Luca Ünlü¹, Johannes A Griese², Bruno Minotti², Christopher R Carpenter³, Christian Appenzeller-Herzog⁴, Philipp Sterzer⁵, Michael Christ⁶, Navid Azad², Kimberly Nordstrom⁷, Clare Skinner⁸, Jelmer Alsma⁹, Victor Stiebel¹⁰, Simon Kurzhals¹¹, Ian Ward Abdalla Maia¹², Roland Bingisser², Michael P Wilson¹³, Christian H Nickel¹⁴

Affiliations

¹ Department of Emergency Medicine University Hospital Basel, Basel Stadt, Switzerland; Department of Emergency Medicine, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.
² Department of Emergency Medicine University Hospital Basel, Basel Stadt, Switzerland.
³ Department of Emergency Medicine, Mayo Medical Center, Rochester, MN.
⁴ University Medical Library, University of Basel, Basel, Switzerland.
⁵ Department of Psychiatry, University of Basel, Basel, Switzerland.
⁶ Department of Emergency Medicine, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
⁷ Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO.
⁸ Department of Emergency Medicine, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.
⁹ Section Acute Medicine, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
¹⁰ Department of Emergency Medicine, West Virginia University Health System, Morgantown, WV.
¹¹ Department of Psychiatry, Evangelische Kliniken Essen-Mitte gGmbH, Essen, North Rhine-Westphalia, Germany.
¹² Department of Emergency Medicine, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
¹³ Department of Emergency Medicine, Carilion Medical Center, Roanoke, VI; Department of Psychiatry, Carilion Medical Center, Roanoke, VI.
¹⁴ Department of Emergency Medicine University Hospital Basel, Basel Stadt, Switzerland; Research Unit for Emergency Medicine, Odense University Hospital, Odense, Denmark. Electronic address: christian.nickel@usb.ch.

PMID: 42233919
DOI: 10.1016/j.annemergmed.2026.04.001

Abstract

Study objective: Medical screening (often termed "medical clearance") is often performed to exclude acute medical conditions in psychiatric emergency department (ED) presentations. This scoping review aims to map and appraise the currently available literature on medical screening of adult (18 years and older) patients with psychiatric complaints in the ED.

Methods: We searched Medline, PsycInfo, EMBASE, and Web of Science from inception to April 2025, supplemented by citation searching and expert consultation. Eligible studies of any design included adult patients with psychiatric complaints presenting to general EDs and reported on medical screening practices. Key study characteristics were charted from all eligible articles. Original research articles and society statements underwent thematic analysis.

Results: Of 9,128 records screened, 145 publications met inclusion criteria, including 62 original research articles, 74 nonoriginal publications, and 9 society recommendations. Among original research articles with primarily retrospective study design (59.7%) on 34,836 patients and 1,149 health care professionals, we identified 8 themes: laboratory testing (38, 62.9%), history taking (22 studies, 35.5%), vital signs (21, 33.9%), physical examination (19, 30.6%), diagnostic imaging (13, 21.0%), medical screening tools (10, 16.1%), electrocardiography (9, 14.5%), and system-level factors (8, 12.9%). Nonoriginal publications were tabulated. Most society recommendations discouraged routine laboratory testing of psychiatric ED presentations and called for collaboration between emergency medicine and psychiatry stakeholders. None of the society recommendations perfectly adhered to either the National Academy of Medicine recommendations for creating trustworthy guidelines or Grading of Recommendations Assessment, Development and Evaluation methodology.

Conclusions: Medical screening practices can be categorized into 8 distinct themes, with the greatest amount of data available for laboratory testing, history taking, and vital sign assessment. Studies are predominantly retrospective and high-quality prospective assessments of the diagnostic accuracy of medical screening practices are warranted.

Keywords: Medical clearance; Medical evaluation; Medical screening; Mental health; Psychiatry.