Detecting Suicide Risk in a Pediatric Emergency Department: Development of a Brief Screening Tool

Abstract

A brief 4-item screening tool can be used by nonmental health clinicians to accurately detect suicidality in children and adolescents who visit an ED. Early and accurate identification of suicidality is a critical first step that could lead to better treatment and improved health outcomes for children and adolescents with mental health concerns.

Evaluation of Predictors of Suicidal Re-Attempt in Pediatric Patients in the Emergency Department

“…It is known that, only in the United behavior and current stressors) had the highest sensitivity [18]. Lately in 2012, they developed a 4-question screening instrument, the Ask Suicide-Screening Questions (ASQ).…”

Is Screening for Suicidal Risk and Hazardous Drinking Possible in a Level 1 Trauma Center?

“…The questions are answered with either a "yes" or "no" response. A "yes" answer or having "no response" accompanied by nonverbal behaviors of concern to any of the RSQ four questions constitutes a positive screen [2].…”

Evaluation and Management of Children With Acute Mental Health or Behavioral Problems. Part II: Recognition of Clinically Challenging Mental Health Related Conditions Presenting With Medical or Uncertain Symptoms

“…146 -148 A 4-question adolescent suicide screen has been shown to have good sensitivity, specificity, and predictive value across a range of teenagers seeking care in the ED and can be accurately administered by nonmental health professionals. [149][150][151] Similarly, an 8-question screen was shown to have excellent predictive characteristics for detecting posttraumatic stress symptoms in children who sustained traffic-related injuries. 152 Given the clinical and time pressures of the ED setting, it is important that mental health screening be acceptable to adolescents, their parents, and ED clinicians.…”

“…157 The Home, Education, Activities and Peers, Drugs and Alcohol, Suicidality, Emotions and Behaviors, Discharge Resources (HEADS-ED) was found to be reliable and accurate, with good concurrent and predictive validity for future psychiatric evaluation and hospitalization. 158 Horowitz et al 149,151,159 have performed several studies on ED suicide screening, most recently by using multiple logistic regression modeling to determine which suicide screening questions best screen for and identify occult suicidal youth. 150 A 4-question model was found to optimize sensitivity (97%; 95% CI, 91%-99%), specificity (88%; 95% CI, 84%-91%), and negative predictive value (99%, 95% CI, 98%-99%) for ED patients presenting with both psychiatric and nonpsychiatric conditions.…”