Value of systematic somatic assessment of adult patients with psychiatric presentations in the emergency department

Introduction. - During a consultation with a psychiatric presentation in emergency departments (EDs), a somatic examination is often performed. However, the value of systematic somatic assessment remains debated. Materials and methods. - Multicenter study in three EDs, retrospective, over two months, including all major patients consulting in an ED for psychiatric reason, without associated intoxication. The primary objective was to evaluate the rate of consultations in which a somatic etiology was found on admission and at D7. The secondary objective was to look for initial clinical features predicting the risk of an underlying somatic problem in ED. Results. - In all, 638 consultations were included. Main reasons were anxiety (35.7%) and depression (35.7%). Psychiatric history was found in 60.7% of cases. No abnormalities in the vitals parameters were found in 412 cases (64.6%) during the nurse screening. A somatic etiology related to the reason for consultation was found in ED on day 0 for 38 (6.0%) consultations. The hospitalization rate was 47.3%, mainly in psychiatry (87.4%). Analysis of the files revealed 63 (10.9%) somatic adverse events at D7, which may have created or increased psychiatric symptoms. The somatic cause found (55.6% of new pathologies) was neurological in 34.9% of cases, metabolic in 30.1%, and infectious in 12.6%. Factors correlated with a somatic etiology at admission were (P < 0.001 for all): older age: 64.5 [46.5- 83.8] vs. 37 [25-54] years; the presence of behavioral disorders: 68.4% vs. 29.3% or delusions: 36.8% vs. 9.8%; the existence of a history of cardiological, neurological, renal or metabolic disorders; the presence of at least one abnormal parameter at the time of the nurse triage: 63.2% vs. 33.7%. In young patients (< 45 years), with no history other than psychiatric, no delusions or behavioral problems, and no abnormalities on the nurse triage, we found a significant somatic etiology in 1% of cases on admission and 3.2% of cases at D7. Conclusion. - The prevalence of somatic problems in patients with a psychiatric presentation is low in our study but somatic examination remains desirable for certain categories of patients where the incidence of somatic pathology is higher. (C) 2022 Elsevier Masson SAS. All rights reserved.