{"title":"调查、病史和体格检查在精神病人“医学检查”中的效用:一项荟萃分析。","authors":"Anil Srivastava, Rajesh Nair","doi":"10.1176/appi.ps.202000858","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Few reviews and no meta-analyses have explored the utility of investigations, such as laboratory tests, among patients presenting with psychiatric symptoms, and none has explored the yield of history and physical examination. A meta-analysis of studies exploring the utility of \"medical clearance\" among adult psychiatric patients was conducted.</p><p><strong>Methods: </strong>PubMed, PsycInfo, and Web of Science were systematically searched from inception until February 15, 2021. Primary outcome was detection by investigations (e.g., bloodwork and imaging), history, or physical examination of an illness that caused or aggravated psychiatric symptoms or was comorbid and that resulted in change in the patient's diagnosis or management (\"yield\"). A mixed-effects meta-analysis with inverse-variance weighting was used to pool results.</p><p><strong>Results: </strong>Twenty-five cross-sectional studies were included. Pooled yield of investigations was 1.1% (95% confidence interval [CI]=0.5%-2.2%), although yield was relatively higher among disoriented, agitated, or older patients. Yield was higher in the inpatient setting, compared with the emergency room, with similar results by approach (protocolized versus nonprotocolized). Compared with investigations, yield of history and physical examination was higher (15.6%, 95% CI=9.1%-25.6%, and 14.9%, 95% CI=8.1%-25.9%, respectively), with nonsignificant differences by evaluator (psychiatrist versus nonpsychiatrist) for physical examination.</p><p><strong>Conclusions: </strong>Investigations were of relatively low yield, especially when weighed against cost and potential harm, and they should not be routinely conducted for patients presenting with primarily psychiatric complaints, although certain subgroups may benefit. History and physical examination, by contrast, should be undertaken for all patients, ideally with participation of the consulting psychiatrist.</p>","PeriodicalId":520759,"journal":{"name":"Psychiatric services (Washington, D.C.)","volume":" ","pages":"1140-1152"},"PeriodicalIF":3.2000,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Utility of Investigations, History, and Physical Examination in \\\"Medical Clearance\\\" of Psychiatric Patients: A Meta-Analysis.\",\"authors\":\"Anil Srivastava, Rajesh Nair\",\"doi\":\"10.1176/appi.ps.202000858\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Few reviews and no meta-analyses have explored the utility of investigations, such as laboratory tests, among patients presenting with psychiatric symptoms, and none has explored the yield of history and physical examination. A meta-analysis of studies exploring the utility of \\\"medical clearance\\\" among adult psychiatric patients was conducted.</p><p><strong>Methods: </strong>PubMed, PsycInfo, and Web of Science were systematically searched from inception until February 15, 2021. Primary outcome was detection by investigations (e.g., bloodwork and imaging), history, or physical examination of an illness that caused or aggravated psychiatric symptoms or was comorbid and that resulted in change in the patient's diagnosis or management (\\\"yield\\\"). A mixed-effects meta-analysis with inverse-variance weighting was used to pool results.</p><p><strong>Results: </strong>Twenty-five cross-sectional studies were included. Pooled yield of investigations was 1.1% (95% confidence interval [CI]=0.5%-2.2%), although yield was relatively higher among disoriented, agitated, or older patients. Yield was higher in the inpatient setting, compared with the emergency room, with similar results by approach (protocolized versus nonprotocolized). Compared with investigations, yield of history and physical examination was higher (15.6%, 95% CI=9.1%-25.6%, and 14.9%, 95% CI=8.1%-25.9%, respectively), with nonsignificant differences by evaluator (psychiatrist versus nonpsychiatrist) for physical examination.</p><p><strong>Conclusions: </strong>Investigations were of relatively low yield, especially when weighed against cost and potential harm, and they should not be routinely conducted for patients presenting with primarily psychiatric complaints, although certain subgroups may benefit. 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引用次数: 0
摘要
目的:很少有综述和荟萃分析探讨调查的效用,如实验室检查,在出现精神症状的患者中,没有人探讨病史和体格检查的结果。一项探讨“医疗许可”在成年精神病患者中的效用的研究进行了荟萃分析。方法:系统检索PubMed、PsycInfo和Web of Science,检索时间为建刊至2021年2月15日。主要结局是通过调查(如血检和影像学检查)、病史或体格检查发现引起或加重精神症状或共病并导致患者诊断或治疗改变的疾病(“预后”)。采用反方差加权的混合效应荟萃分析汇总结果。结果:纳入了25项横断面研究。调查的合并成功率为1.1%(95%可信区间[CI]=0.5%-2.2%),尽管在定向障碍、躁动或老年患者中成功率相对较高。与急诊室相比,住院治疗的成功率更高,不同治疗方法(治疗方案与非治疗方案)的结果相似。与调查相比,病史和体格检查的检出率更高(分别为15.6%,95% CI=9.1%-25.6%和14.9%,95% CI=8.1%-25.9%),评估者(精神科医师与非精神科医师)体格检查的差异不显著。结论:调查的结果相对较低,尤其是在权衡成本和潜在危害的情况下,尽管某些亚组可能受益,但不应该对主要表现为精神疾病的患者常规进行调查。相比之下,所有患者都应该进行病史和体格检查,最好有咨询精神科医生的参与。
Utility of Investigations, History, and Physical Examination in "Medical Clearance" of Psychiatric Patients: A Meta-Analysis.
Objective: Few reviews and no meta-analyses have explored the utility of investigations, such as laboratory tests, among patients presenting with psychiatric symptoms, and none has explored the yield of history and physical examination. A meta-analysis of studies exploring the utility of "medical clearance" among adult psychiatric patients was conducted.
Methods: PubMed, PsycInfo, and Web of Science were systematically searched from inception until February 15, 2021. Primary outcome was detection by investigations (e.g., bloodwork and imaging), history, or physical examination of an illness that caused or aggravated psychiatric symptoms or was comorbid and that resulted in change in the patient's diagnosis or management ("yield"). A mixed-effects meta-analysis with inverse-variance weighting was used to pool results.
Results: Twenty-five cross-sectional studies were included. Pooled yield of investigations was 1.1% (95% confidence interval [CI]=0.5%-2.2%), although yield was relatively higher among disoriented, agitated, or older patients. Yield was higher in the inpatient setting, compared with the emergency room, with similar results by approach (protocolized versus nonprotocolized). Compared with investigations, yield of history and physical examination was higher (15.6%, 95% CI=9.1%-25.6%, and 14.9%, 95% CI=8.1%-25.9%, respectively), with nonsignificant differences by evaluator (psychiatrist versus nonpsychiatrist) for physical examination.
Conclusions: Investigations were of relatively low yield, especially when weighed against cost and potential harm, and they should not be routinely conducted for patients presenting with primarily psychiatric complaints, although certain subgroups may benefit. History and physical examination, by contrast, should be undertaken for all patients, ideally with participation of the consulting psychiatrist.