Objective
To develop a brief screening instrument to assess risk of suicide in pediatric emergency department (ED) patients.
Design
A prospective, cross-sectional instrument development study which evaluated 17 candidate screening questions assessing suicide risk in young patients. The Suicidal Ideation Questionnaire (SIQ) served as criterion standard.
Setting
Three urban, pediatric EDs associated with tertiary care teaching hospitals.
Patients/Participants
A convenience sample of 524 patients aged 10–21 years who presented with either medical/surgical or psychiatric chief complaints to the ED between September 2008–December 2010.
Main Exposure
Participants answered 17 candidate questions followed by the SIQ.
Main Outcome Measures
Sensitivity, specificity, predictive values, likelihood ratios, and area under the receiver operating characteristic curves of the best-fitting combinations of screening questions for detecting elevated risk of suicide.
Results
524 patients were screened (344 medical/surgical and 180 psychiatric). Fourteen (4%) of the medical/surgical patients and 84 (47%) of the psychiatric patients were at elevated suicide risk on the SIQ. Of the 17 candidate questions, the best-fitting model was comprised of 4 questions assessing: current thoughts of being better off dead, current wish to die, current suicidal ideation, and past suicide attempt. This model had a sensitivity of 96.9% (95% CI, 91.3%–99.4%), specificity of 87.6% (95% CI, 84.0%–90.5%), and a negative predictive value (NPV) of 99.7% (95% CI, 98.2%–99.9%) for medical/surgical patients; 96.9% (95% CI, 89.3%–99.6%) for psychiatric patients.
Conclusions
A four-question screening instrument, the Ask Suicide-Screening Questions (ASQ), with high sensitivity and NPV, can identify risk of suicide in patients presenting to pediatric EDs.
Family-based crisis intervention is a model of care for suicidal adolescents that may be a viable alternative to traditional ED care that involves inpatient psychiatric hospitalization.
Suicidal patients continue to board. Limits within the system, including timing of ED presentation and a dearth of specialized services, still exist, elevating the risk of boarding for some populations. Implications for pediatric ED psychiatric care delivery are discussed.
Boarders are a problem in pediatrics, and this study identifies multiple characteristics that were associated with increasing a youth's odds of becoming a boarder at this institution. The suicidal and homicidal symptom results suggest a reverse triage system in which sicker patients are not necessarily given priority by psychiatric facilities. These data highlight mental health practices that need to be reassessed to ensure optimal care for youths with acute mental illness.
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