Routine Lab Testing Not Needed for Children with Psychiatric Complaints
Katherine Bakes, MD
Testing increased length of stay but rarely influenced disposition decisions.
Do screening laboratory tests result in management or disposition changes for children who present with psychiatric concerns? To find out, investigators retrospectively reviewed charts for 1082 children (mean age, 14 years) who presented to a pediatric emergency department with danger to self or others, grave disability, or involuntary psychiatric hold during an 18-month period. The study site lacked inpatient psychiatric capabilities, and laboratory tests were performed as part of a standard medical clearance protocol required by designated psychiatric receiving facilities. The tests were complete blood counts, serum electrolyte levels, liver function tests, thyroid stimulating hormone levels, urine pregnancy tests, rapid plasma reagents, and urinalysis.
A total of 13,725 laboratory tests were performed in 871 visits (81%); the remaining patients were sent to facilities that did not require testing. An abnormal test result was associated with a change in management in 50 visits (6%) and a change in disposition in 7 (1%). History and physical examination findings contributed to half the management changes and 6 of the 7 disposition changes (one patient with a positive pregnancy test but noncontributory history and physical exam was admitted for unknown reasons). Hemoglobin level and urinalysis were the tests most frequently associated with changes in management (7% and 4% of those tests, respectively). Median emergency department length of stay was 117 minutes longer with testing than without.
Citation(s):
Donofrio JJ et al. Clinical utility of screening laboratory tests in pediatric psychiatric patients presenting to the emergency department for medical clearance. Ann Emerg Med 2013 Nov 11; [e-pub ahead of print].
