International Delphi on a medical screening tool for emergency department patients with psychiatric complaints
Abstract
Background:: Medical screening in the emergency department (ED) is performed to identify underlying medical conditions that may contribute to a patient’s psychiatric presentation and/or require treatment. This process frequently causes disagreement between emergency physicians and psychiatrists regarding objectives and scope of medical screening, leading to potentially unnecessary testing, prolonged ED length-of-stay, and increased costs. This study aims to develop an evidence-informed and consensus-based medical screening tool through a transdisciplinary, international Delphi process.
Methods:: This modified international Delphi study was conducted between May and November 2025 using a 4-round modified Delphi process with online surveys and online steering committee discussions. Participants included 25 society representatives from 7 emergency medicine and psychiatry societies across 4 continents and 6 patient representatives with prior ED medical screening experience as patients or patient relatives. Participants generated, rated, refined, and reached consensus on proposed screening elements. Consensus was predefined as ≥80% agreement in Round 3. In Round 4, the resulting tool was applied to 37 standardized clinical vignettes. Interrater agreement was assessed using Gwet agreement coefficient (AC).
Results:: Of 28 invited society representatives and steering committee members, 25 (89.3%) participated in Round 1, 23 (82.1%) in Round 2, 22 (78.6%) in Round 3, and 23 (82.1%) in Round 4. The 6 patient representatives completed all 4 rounds. In Round 1, participants generated 91 statements from society representatives and 27 from patient representatives. Following refinement in Round 2, consensus in Round 3 was achieved for 48 of 91 society representatives’ statements (52.8%) and 21 of 27 patient statements (77.8%), which were synthesized into the Delphi-Informed Medical Evaluation (DIME) tool. In Round 4, application of the draft DIME tool to 37 clinical vignettes demonstrated almost perfect agreement among society representatives (Gwet AC, 0.86; 95%-CI 0.78–0.93; p < .001) and substantial agreement among patient representatives (Gwet AC, 0.76; 95%-CI 0.66–0.86; p < .001).
Conclusions: This international modified Delphi study developed the DIME tool, a consensus-based medical screening tool to identify adult ED patients with psychiatric complaints who are at low risk for acute medical illness. Prospective multicenter validation studies are required before clinical implementation.
Trial registration: clinicaltrials.gov, NCT06936826
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BibTeX
@article{unlu2026international,
title = {{International Delphi on a medical screening tool for emergency department patients with psychiatric complaints}},
author = {Luca Ünlü and Christopher R. Carpenter and Philipp Sterzer and Michael Christ and Navid Azad and Johannes A. Griese and Kimberly Nordstrom and Clare Skinner and Jelmer Alsma and Victor Stiebel and Simon Kurzhals and Elise Pascoe and Teri Brister and Erik van der Eycken and Ian Ward Abdalla Maia and Judith Tintinalli and Roland Bingisser and Michael P. Wilson and Christian H. Nickel and and the Delphi Informed Medical Evaluation (DIME) study group and Kyle Jasper and Laura Joyce and Nasuh Malas and Anthony Ng and Lucas Oliveira J. E. Silva and Joe Anthony Rotella and Maria Sagué Vilavella and David Baden and Fatine Hamza and Tim Harris and Joris van der Vlugt and Leslie S. Zun},
journal = {BMC Medicine},
year = {2026},
month = oct,
doi = {10.1186/s12916-026-05324-7},
url = {https://link.springer.com/article/10.1186/s12916-026-05324-7},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - International Delphi on a medical screening tool for emergency department patients with psychiatric complaints
AU - Luca Ünlü
AU - Christopher R. Carpenter
AU - Philipp Sterzer
AU - Michael Christ
AU - Navid Azad
AU - Johannes A. Griese
AU - Kimberly Nordstrom
AU - Clare Skinner
AU - Jelmer Alsma
AU - Victor Stiebel
AU - Simon Kurzhals
AU - Elise Pascoe
AU - Teri Brister
AU - Erik van der Eycken
AU - Ian Ward Abdalla Maia
AU - Judith Tintinalli
AU - Roland Bingisser
AU - Michael P. Wilson
AU - Christian H. Nickel
AU - and the Delphi Informed Medical Evaluation (DIME) study group
AU - Kyle Jasper
AU - Laura Joyce
AU - Nasuh Malas
AU - Anthony Ng
AU - Lucas Oliveira J. E. Silva
AU - Joe Anthony Rotella
AU - Maria Sagué Vilavella
AU - David Baden
AU - Fatine Hamza
AU - Tim Harris
AU - Joris van der Vlugt
AU - Leslie S. Zun
PY - 2026
DA - 2026/10/17
JO - BMC Medicine
DO - 10.1186/s12916-026-05324-7
UR - https://link.springer.com/article/10.1186/s12916-026-05324-7
AB - Background:: Medical screening in the emergency department (ED) is performed to identify underlying medical conditions that may contribute to a patient’s psychiatric presentation and/or require treatment. This process frequently causes disagreement between emergency physicians and psychiatrists regarding objectives and scope of medical screening, leading to potentially unnecessary testing, prolonged ED length-of-stay, and increased costs. This study aims to develop an evidence-informed and consensus-based medical screening tool through a transdisciplinary, international Delphi process. Methods:: This modified international Delphi study was conducted between May and November 2025 using a 4-round modified Delphi process with online surveys and online steering committee discussions. Participants included 25 society representatives from 7 emergency medicine and psychiatry societies across 4 continents and 6 patient representatives with prior ED medical screening experience as patients or patient relatives. Participants generated, rated, refined, and reached consensus on proposed screening elements. Consensus was predefined as ≥80% agreement in Round 3. In Round 4, the resulting tool was applied to 37 standardized clinical vignettes. Interrater agreement was assessed using Gwet agreement coefficient (AC). Results:: Of 28 invited society representatives and steering committee members, 25 (89.3%) participated in Round 1, 23 (82.1%) in Round 2, 22 (78.6%) in Round 3, and 23 (82.1%) in Round 4. The 6 patient representatives completed all 4 rounds. In Round 1, participants generated 91 statements from society representatives and 27 from patient representatives. Following refinement in Round 2, consensus in Round 3 was achieved for 48 of 91 society representatives’ statements (52.8%) and 21 of 27 patient statements (77.8%), which were synthesized into the Delphi-Informed Medical Evaluation (DIME) tool. In Round 4, application of the draft DIME tool to 37 clinical vignettes demonstrated almost perfect agreement among society representatives (Gwet AC, 0.86; 95%-CI 0.78–0.93; p < .001) and substantial agreement among patient representatives (Gwet AC, 0.76; 95%-CI 0.66–0.86; p < .001). Conclusions: This international modified Delphi study developed the DIME tool, a consensus-based medical screening tool to identify adult ED patients with psychiatric complaints who are at low risk for acute medical illness. Prospective multicenter validation studies are required before clinical implementation. Trial registration: clinicaltrials.gov, NCT06936826
SN - 1741-7015
ER -