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The following is a summary of “Shah’s Score After a Decade: Is It Still a Reliable Tool for Psychiatric Screening in the Emergency Department?,” published in the February 2025 issue of Journal of Emergency Medicine by Mesbah et al.
Mental health emergency department (ED) visits reached 6 million in 2024, highlighting the need for better diagnostic tools and triage systems, which led to the creation of Shah’s score.
Researchers conducted a retrospective study to examine Shah’s score accuracy and potential improvements, aiming to balance care for this underserved population with appropriate ED resource utilization.
They analyzed data from May 1, 2020 – May 30, 2021, at an urban academic Level I trauma center. Electronic medical records of adults visiting the ED with psychiatric chief complaints at a large urban teaching hospital were reviewed. Exclusion criteria included pregnancy, incarceration, or incomplete records. Records were analyzed for acute medical diagnoses and management, with data reported as mean (SD) and evaluated using Pearson’s χ2 test.
The results showed that out of 1,613 patients screened, 507 met the inclusion criteria. The average age was 39.1 years (±14); 66.7% were male and 49.7% were African American. Suicidality was the most common complaint (49.9%), with 55.0% presenting voluntarily and 89.9% undergoing laboratory tests. Dispositions were 61.9% discharged from the ED, 35.5% admitted to the psychiatric unit, and 2.6% admitted to the medical service. The Shah score cleared 76.73% of patients, although 8 patients cleared by the score later required admission due to acute kidney injury, uncontrolled hypertension, thyroid cancer, anticoagulation issues, and inability to perform daily activities (ADLs). The Shah score demonstrated a negative predictive value (NPV) of 97.94% (95.99%-99.12%) for identifying patients receiving psychiatric care who did not require further medical workup.
Investigators concluded that the Shah score showed promise in improving clinical safety and effectiveness.
Source: jem-journal.com/article/S0736-4679(25)00054-X/abstract
