Assessment of Selective and Universal Screening for Suicide Risk in a Pediatric Emergency Department

Abstract

Key PointsQuestionAre results of universal and selective screening for suicide risk implemented in a pediatric emergency department associated with future suicidal behaviors?FindingsIn this cohort study of 15 003 youths aged 8 to 18 years, positive screens were significantly associated with subsequent suicide-related hospital visits compared with standard emergency department procedures. Screening also more than doubled the detection of suicide risk compared with treatment as usual.MeaningThese findings suggest that screening for suicide risk in pediatric emergency departments is an effective approach to identify risk for subsequent suicide-related emergency department visits.

Comparing the predictive value of suicide risk screening to the detection of suicide risk using electronic health records in an urban pediatric emergency department

“…Our outcome was a binary indicator for pattern matched terms “suicide”, “suicidal”, “suicide ideation”, “suicide gesture”, “self-cutting”, “self-harm”, “self-injury”, “self-injurious”, “self-inflicted”, “self-mutilation”, “self-mutilating”, “suicide attempt”, and “attempted suicide” on either PED chief complaint or presenting diagnosis. As a sensitivity analysis, we compared our pattern matched outcome measure to manually scored suicidal behaviors for overlapping patients in data from DeVylder et al 15…”

“…Twenty-five medical and psychiatric condition categories were obtained from the Centers for Medicare and Medicaid Services (CMS) Chronic Conditions Warehouse (CCW) and were matched to ICD codes extracted from index PED visits. The CCW markers were chosen on the basis of prior utility in PED suicide risk prediction, 15 plausibility for incidence within the pediatric population (i.e. excluding conditions such as stroke, hip fracture, osteoporosis), and potential relevance for other clinical settings.…”

“…12 More broadly, the US Action Alliance’s “Zero Suicide” (ZS) model for suicide prevention in healthcare systems includes universal screening for suicide risk at all points of care in a healthcare setting as one of several essential elements. 13 Studies have shown that use of brief screeners is feasible, 14 that positive screens are significantly associated with subsequent suicide-related hospital visits, 15 and that screening may double detection of those most at risk. 15,16 However, implementation of screening involves several important hurdles, including generating buy-in from hospital administrators, programming of screeners into the electronic health record (EHR), training of staff in screening procedures and appropriate triage actions, and ongoing monitoring of fidelity to the instrument and process.…”

“…13 Studies have shown that use of brief screeners is feasible, 14 that positive screens are significantly associated with subsequent suicide-related hospital visits, 15 and that screening may double detection of those most at risk. 15,16 However, implementation of screening involves several important hurdles, including generating buy-in from hospital administrators, programming of screeners into the electronic health record (EHR), training of staff in screening procedures and appropriate triage actions, and ongoing monitoring of fidelity to the instrument and process. 14,17–19 Many screeners, which generally center on the question of suicidal ideation, can suffer from both high rates of false positives as well as even more dangerous false negatives, which can create a false sense that risk has been appropriately ruled in or out.…”

Introducing an innovative model of acute paediatric mental health and addictions care to paediatric emergency departments: a protocol for a multicentre prospective cohort study

“…It has been validated for children and youth, 5 26–29 and has excellent diagnostic test characteristics including a negative predictive value of 99.6% to detect suicide risk among those seeking emergency care. 30 Because healthcare providers differ in how they ask self-harm/suicide questions and patient responses are influenced by how questions are posed, 31 a standard approach to triage questioning will enhance the ability of nurses to rapidly and accurately identify patients at extremely low risk for self-harm. 32 …”