Accuracy of diagnosis at routine psychiatric assessment in patients presenting to an accident and emergency department.

OBJECTIVE This study aimed to compare diagnoses obtained from routine psychiatric assessment in accident and emergency (A&E) settings with those from a standardized diagnostic interview. METHODS Using Cohen's kappa, the agreement between diagnoses from routine psychiatric assessment and structured interview was calculated. Further statistical analysis was used to investigate differences between some of the main diagnostic subgroups. RESULTS The overall kappa value for all diagnoses was .47. Adjustment disorder, major depressive disorder and alcohol misuse/dependence were commonly identified, both at routine assessment and on structured interview. There was a disparity between the two diagnostic systems in the extent to which major depressive disorder and adjustment disorder were identified. Further analysis between these two groups was inconclusive as to the reasons for this difference. CONCLUSIONS There was moderate agreement between clinical and standardized diagnoses. Anxiety disorders were poorly identified at routine assessment. There is difficulty distinguishing between adjustment disorder and depressive episode in the A&E setting.