Like a Prisoner in Azkaban: Medical Clearance of the Pediatric Psychiatric Patient

Patients presenting with behavioral and psychiatric emergencies represent over 7% of all pediatric Emergency Department (ED) visits. Emergency personnel provide not only acute crisis intervention and stabilization but are tasked with “medically clearing” these children and adolescents for inpatient treatment. As will be discussed in this review article, the goal of medical clearance is to ensure that the patient’s condition is caused by true psychological pathology as opposed to underlying medical problems and that these patients may be safely be transferred to inpatient facilities. The extent of laboratory and ancillary testing is hotly debated and the process as a whole is crippled by the lack of interdisciplinary consensus between emergency physicians, pediatricians as well as emergency and inpatient psychiatrists. This article proposes an algorithm to help guide the process of medical clearance of the pediatric psychiatric patient.


Edore Onigu-Otite, Oluwadolapo Abimbola Oyebadejo, Nidal Moukaddam, Genevieve Santillanes and Veronica Tucci*

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