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Critical Issues in the Diagnosis and Management of the Adult Psychiatric Patient in the Emergency Department

Official 2017 guideline from the American College of Emergency Physicians.

These guideline summaries are shared for educational purposes only and are not intended to direct patient care. For detail on the specific recommendations and information about the evidence considered by the guideline developer, we encourage you to go to the original guideline statement cited below.

Recommendations

Risk Stratification
Level C
In patients presenting to the emergency department with suicidal ideation, physicians should not use currently available risk-assessment tools in isolation to identify low-risk patients who are safe for discharge. The best approach to determine risk is an appropriate psychiatric assessment and good clinical judgment, taking patient, family, and community factors into account.
Laboratory Testing
Level C
Do not routinely order laboratory testing on patients with acute psychiatric symptoms. Use medical history, previous psychiatric diagnoses, and physician examination to guide testing.
Brain Imaging
Level C
Use individual assessment of risk factors to guide brain imaging in the emergency department for patients with new-onset psychosis without focal neurologic deficit. [Consensus recommendation]
Ketamine for Agitation
Level C
Ketamine is one option for immediate sedation of the severely agitated patient who may be violent or aggressive. [Consensus recommendation]
Literature
Original/Primary Reference
Research PaperNazarian DJ, Broder JS, Thiessen MEW, et al. American College of Emergency Physicians. Clinical Policy: Critical Issues in the Diagnosis and Management of the Adult Psychiatric Patient in the Emergency Department. Ann Emerg Med. 2017;69(4):480-498.