Diagnostic yield of head CT in pediatric emergency department patients with acute psychosis or hallucinations

Cunqueiro, Alain; Durango, Alejandra; Fein, Daniel M.; Ye, Kenny; Scheinfeld, Meir H.

doi:10.1007/s00247-018-4265-y

Cited by 5 publications

(7 citation statements)

References 16 publications

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Section: Discussionsupporting

confidence: 91%

“…Our findings are consistent with previous studies, which have called into question the utility of comprehensive and indiscriminate medical clearance for psychiatric admission. [3][4][5] Broadly speaking, psychotropic medications can have increased cardiovascular risk in the setting of nodal dysfunction, conduction disturbances, and/ or structural abnormalities. Specifically, lithium and carbamazepine can worsen heart block; some antipsychotics and antidepressants can trigger torsade de pointes in the setting of prolonged QTc interval; and stimulants can increase risk for sudden cardiac death in individuals with hypertrophic cardiomyopathy.…”

Section: Discussionmentioning

confidence: 99%

“…Studies have demonstrated that both routine laboratory tests and head computed tomography have low diagnostic yield when conducted on otherwise healthy patients as part of this screening process. [3][4][5] So far, no studies have looked specifically at the use of screening ECGs in the medical clearance process. Electrocardiograms are often indicated in the medical evaluation of psychiatric patients with recent overdose, eating disorders, or cardiac symptoms, such as chest pain or palpitations.…”

mentioning

confidence: 99%

“…These tests can be costly and are of unclear utility. Studies have demonstrated that both routine laboratory tests and head computed tomography have low diagnostic yield when conducted on otherwise healthy patients as part of this screening process 3–5 …”

mentioning

confidence: 99%

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Screening Electrocardiograms Have Low Utility in Medical Clearance Before Pediatric Inpatient Psychiatric Admission

et al. 2020

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Objectives: Children presenting to the emergency department (ED) requiring psychiatric admission often undergo screening electrocardiograms (ECG) as part of the medical clearance process. The diagnostic yield of screening ECGs for this purpose has not been reported. The purpose of this study was to determine the clinical utility of screening ECGs in children and adolescents requiring acute inpatient psychiatric admission.Methods: A single-center retrospective study of patients aged 5 to 18 years who did not have documented indications for ECG and underwent screening ECG before psychiatric inpatient admission over a 2-year period was conducted. Abnormal ECGs were identified via chart review and were reinterpreted by a pediatric cardiologist to determine potential significance to psychiatric care. Impact on treatment and disposition was examined.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Screening Electrocardiograms Have Low Utility in Medical Clearance Before Pediatric Inpatient Psychiatric Admission

et al. 2020

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“…43 However, in patients without suggestive indications on history or examination, abnormalities that would influence treatment or require follow-up (including potentially serious incidental findings) were found in <1% of imaging studies. 44,48 Therefore, we recommend consideration of MRI brain with and without contrast in patients with high clinical suspicion or potential to benefit in keeping with current APA practice guidelines.…”

Section: Neuroimagingmentioning

confidence: 93%

Approach to New-Onset Psychosis in Pediatrics: A Review of Current Practice and an Interdisciplinary Consensus-Driven Clinical Pathway at a Single-Center Institution

et al. 2023

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New-onset psychosis in the pediatric population poses many diagnostic challenges. Given the diversity of underlying causes, which fall under the purview of multiple medical specialties, a timely, targeted, yet thorough workup requires a systematic and coordinated approach. A committee of expert pediatric physicians from the divisions of emergency medicine, psychiatry, neurology, hospitalist medicine, and radiology convened to create and implement a novel clinical pathway and approach to the pediatric patient presenting with new-onset psychosis. Here we provide background and review the evidence supporting the investigations recommended in our pathway to screen for a comprehensive range of etiologies of pediatric psychosis.

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Management of youth with suicidal ideation: Challenges and best practices for emergency departments

Santillanes,

Foster,

Ishimine

et al. 2024

JACEP Open

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Suicide is a leading cause of death among youth, and emergency departments (EDs) play an important role in caring for youth with suicidality. Shortages in outpatient and inpatient mental and behavioral health capacity combined with a surge in ED visits for youth with suicidal ideation (SI) and self‐harm challenge many EDs in the United States. This review highlights currently identified best practices that all EDs can implement in suicide screening, assessment of youth with self‐harm and SI, care for patients awaiting inpatient psychiatric care, and discharge planning for youth determined not to require inpatient treatment. We will also highlight several controversies and challenges in implementation of these best practices in the ED. An enhanced continuum of care model recommended for youth with mental and behavioral health crises utilizes crisis lines, mobile crisis units, crisis receiving and stabilization units, and also maximizes interventions in home‐ and community‐based settings. However, while local systems work to enhance continuum capacity, EDs remain a critical part of crisis care. Currently, EDs face barriers to providing optimal treatment for youth in crisis due to inadequate resources including the ability to obtain emergent mental health consultations via on‐site professionals, telepsychiatry, and ED transfer agreements. To reduce ED utilization and better facilitate safe dispositions from EDs, the expansion of community‐ and home‐based services, pediatric‐receiving crisis stabilization units, inpatient psychiatric services, among other innovative solutions, is necessary.

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Diagnostic yield of head CT in pediatric emergency department patients with acute psychosis or hallucinations

Cited by 5 publications

References 16 publications

Screening Electrocardiograms Have Low Utility in Medical Clearance Before Pediatric Inpatient Psychiatric Admission

Screening Electrocardiograms Have Low Utility in Medical Clearance Before Pediatric Inpatient Psychiatric Admission

Approach to New-Onset Psychosis in Pediatrics: A Review of Current Practice and an Interdisciplinary Consensus-Driven Clinical Pathway at a Single-Center Institution

Management of youth with suicidal ideation: Challenges and best practices for emergency departments

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