Utility of Investigations, History, and Physical Examination in ?Medical Clearance? of Psychiatric Patients: A Meta-Analysis

Objective: Few reviews and no meta-analyses have ex-plored the utility of investigations, such as laboratory tests, among patients presenting with psychiatric symptoms, and none has explored the yield of history and physical exami-nation. 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 (proto-colized versus nonprotocolized). Compared with inves-tigations, 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 differ-ences 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 exami-nation, by contrast, should be undertaken for all patients, ideally with participation of the consulting psychiatrist.

Automated summary

This study explored the utility of medical clearance among adult psychiatric patients, finding that investigations had relatively low yield, while history and physical examination had significantly higher yield, especially in disoriented, agitated, or older patients.