Reliability of diagnoses made by psychiatric residents in a general emergency department

The reliability of psychiatric diagnoses made by psychiatric residents in the general emergency department of a university hospital was assessed by comparing those diagnoses with the inpatient discharge diagnoses of patients referred to the hospital's inpatient service from the emergency department. In both settings diagnoses were based on DSM- III-R criteria, but structured diagnostic instruments were not used. Retrospective review of the records of 190 inpatients over a six-month period showed excellent to moderate concordance between principal axis 1 diagnoses in four categories--major depression, schizophrenic disorders, bipolar disorder, and substance abuse and dependence disorders. Kappa values ranged from .64 for major depression to .87 for substance abuse and dependence disorders.