Diagnostic Overshadowing of the Psychiatric Population in the Emergency Department: Physiological Factors Identified for an Early Warning System

Abstract

BACKGROUND: Many people with mental disorders in the United States remain either medically untreated or inadequately treated, which is often attributed to diagnostic overshadowing, a common occurrence across the nation in emergency departments. OBJECTIVE: The aim of this research is to create a tool that supports accurate assessment and distinguishing behavioral symptoms between psychiatric illness and coexisting medical conditions in the emergency department, thus leading to appropriate care and placement. DESIGN: Retrospective cohort design of 133 psychiatric admissions were reviewed between the years 2011 and 2015. RESULTS: Logistic regression retained three factors: age greater than 70 years (odds ratio [OR] = 6.575, 95% confidence interval [CI] = 2.58-16.76), abnormal heart rate (OR = 8.48, 95% CI = 3.39-28.42), and abnormal temperature (OR = 9.82, 95% CI = 3.91-18.40). The three factors were then placed into a screening tool. The presence of each factor equaled 1 point. If the total score was greater than 2, the sensitivity of the tool was 68.7% and the specificity of the tool was 85.8%. CONCLUSIONS: Coexisting medical conditions in the psychiatric population may present as behavioral symptoms; however, the use of a tool that focuses assessment toward medical factors such as abnormal heart rate, abnormal temperature, and advanced age can direct further investigation of behavioral symptoms.