Patterns of medical illness and injuries in emotionally disturbed patients brought to an emergency department in police custody

Introduction

Emotionally disturbed persons brought to the emergency department (ED) are at risk of surgical and medical illness. The patterns of medical and surgical illness for emotionally disturbed patients brought in police custody to a major urban ED were recorded.

Methods

Our electronic ED medical records include the chief complaint, final diagnosis and disposition. A smaller number have detailed nursing notes. All patients with detailed nursing notes who were brought between 1 December 1999 and 31 August 2003 in police custody for psychiatric evaluation were studied. Patients were classified as 'agitated' if they were described as violent, psychotic, aggressive, combative, hostile, threatening, homicidal or dangerous.

Results

In total, 17,733 were brought for psychiatric evaluation. Of these 6,432 had complete nursing notes. Rates of injury and illness were low. Of 1,985 nonagitated patients, 194 (9.8%) were injured: 180 (93%) self-inflected and none was attributed to a restraint process. For 4,447 agitated patients, 227 (3.5%) were injured, 160 (70%) were self-inflicted and 39 (0.9%) were attributed to the restraint process. Of these, 31 were exposed to mace, six had minor head or soft-tissue injuries, one had a pneumothorax, and one had an airway injury. For the subgroup self-inflicted injuries included lacerations (245), head injuries (60), hangings (13), penetrating wounds (10), hand fractures or infection (three), and other minor (nine). Overall 2,903 (45.8%) were admitted to a psychiatric service, 110 (1.7%) to a medical service and seven (0.12%) to a surgical service. Admitted surgical diagnoses were abdominal stab wound (one), tibial fracture (two), pneumothorax (one), airway injury (one), infected human bite (one), complicated lacerations (three), and penile foreign body (one). The predominant medical admission diagnoses were alcohol withdrawal (16 patients), overdose (24 patients), and rhabdomyolysis (12 patients). Forty-five patients had complications of chronic medical illness and eight patients had dementia with by psychosis.

Conclusion

Although serious medical illnesses and injuries occurred, there was a low rate of medical and surgical illness that required admission. There was a high rate of psychiatric admission.