ABSTRACT
This chapter reviews the literature with regard to screening tests in behavioral emergencies and highlights the growing evidence that this is an antiquated practice. In most settings, the current practice is that the emergency physician performs a focused history and physical exam to ensure that there are no urgent medical needs. The medical assessment of the behavioral emergency is predicated on a good history and physical exam. The urine toxicology is felt to yield invaluable information to the psychiatrist, and is at best unhelpful for the emergency physician. Standardized medical screening protocols for psychiatric patients have been developed and studied in the literature. The lab tests, particularly the urine toxicology screen, are costly and provide potentially misleading information. In some regions, comprehensive laboratory evaluation of psychiatric patients is an expectation placed upon local emergency departments by inpatient psychiatric facilities. The result of such an arrangement without application of contemporary evidence produces unnecessary delays, and drives up cost.
