Psychiatry · Internal Medicine · 2 h ago
International Delphi study develops DIME screening tool for psychiatric ED patients
An international, four-round Delphi study involving emergency medicine and psychiatry representatives and patient representatives developed the Delphi-Informed Medical Evaluation (DIME) tool. Agreement was substantial to almost perfect when participants applied the draft tool to 37 standardized clinical vignettes, but prospective validation is needed before clinical use.
- Four-round international Delphi process developed the DIME tool.
- Consensus included input from six patient representatives.
- Vignette agreement was high among society representatives.
- Prospective multicenter validation is needed before implementation.
Medical screening for emergency department (ED) patients presenting with psychiatric complaints can be contentious, with clinicians differing on the need and scope of testing. This modified international Delphi study sought consensus on screening elements for identifying adults at low risk of acute medical illness. From May to November 2025, 25 representatives from seven emergency medicine and psychiatry societies across four continents, along with six patient representatives, completed four rounds of surveys and discussions. Consensus was defined as at least 80% agreement.
The process yielded the Delphi-Informed Medical Evaluation (DIME) tool, based on 48 of 91 statements from society representatives and 21 of 27 statements from patient representatives that reached consensus. When applied to 37 standardized clinical vignettes, agreement was almost perfect among society representatives (Gwet AC 0.86; 95% CI 0.78–0.93) and substantial among patient representatives (0.76; 95% CI 0.66–0.86).
DIME offers a consensus-based approach to screening, but the findings establish agreement on vignettes, not diagnostic accuracy or patient outcomes in routine care. The authors say prospective, multicenter validation is required before implementation. The study was supported by scientific funds from the Emergency Department of University Hospital Basel and open-access funding from the University of Basel.
In practice
DIME is a consensus-based screening tool intended to identify adult ED patients with psychiatric complaints who may be at low risk for acute medical illness. The study shows that society and patient representatives applied its draft criteria consistently to standardized vignettes, but it did not test diagnostic accuracy, safety, or effects on testing and ED length of stay in clinical practice. The tool should therefore be regarded as developmental; prospective multicenter validation is needed before it can inform routine screening decisions.
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BMC Medicine: International Delphi on a medical screening tool for emergency department patients with psychiatric complaints ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.