Original Article

CME Article: Patients on Involuntary Hold Status in the Emergency Department

Authors: Archana Roy, MD, Christian Lachner, MD, Adrian Dumitrascu, MD, Nancy L. Dawson, MD, Tyler F. Vadeboncoeu, MD, Michael J. Maniaci, MD, Ian C. Lamoureux, MD, Patricia C. Lewis, ARNP, Teresa A. Rummans, MD, M. Caroline Burton, MD


Objectives: Patients requiring involuntary holds are frequently seen in the emergency department (ED). Much of what is known comes from studies of patients at urban academic centers. Our aim was to describe the demographic and clinical characteristics of patients who were evaluated while on involuntary status at a suburban ED.

Methods: The medical records of patients seen in the ED requiring involuntary hold status between January 1, 2014 and November 30, 2015 were reviewed. Demographic and clinical variables including medical and psychiatric comorbidity were collected. A subanalysis was performed comparing patients who attempted suicide with all other involuntary patients.

Results: Two hundred fifty-one patient records were reviewed; 215 patients (85.3%) had psychiatric disorders—depression was the most common (57%)—and 108 patients (43%) had substance use disorders. Only 13 patients (5.2%) had neither a psychiatric disorder nor a history of substance use. Twenty-two patients (8.8%) were violent in the ED. Thirteen patients (5.2%) were readmitted, and 1 patient died within 30 days of discharge from the ED. One hundred twenty-four patients (49.4%) had medical disorders. Suicidal ideation was the most common reason for involuntary hold (n = 185, 73.7%); 63 patients (25.1%) attempted suicide. Compared with other involuntary patients, the patients who attempted suicide were less likely to use opiates (odds ratio 0.27, 95% confidence interval 0.08–0.94, P = 0.04) and to have medical disorders (odds ratio 0.52, 95% confidence interval 0.28–0.98, P = 0.04).

Conclusions: Patients in this study differed from those in urban centers with respect to sex and psychiatric disorder; however, substance misuse was common in both settings. Suicidal ideation including suicide attempt was the most common reason for involuntary status. Patients who attempted suicide were similar to other patients on involuntary hold with respect to demographic and clinical variables.

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