Identification of At-Risk Youth by Suicide Screening in a Pediatric Emergency Department

Abstract

Objective The pediatric emergency department (ED) is a critical location for the identification of children and adolescents at risk for suicide. Screening instruments that can be easily incorporated into clinical practice in EDs to identify and intervene with patients at increased suicide risk is a promising suicide prevention strategy and patient safety objective. This study is a retrospective review of the implementation of a brief suicide screen for pediatric psychiatric ED patients as standard of care. Methods The ASQ (Ask Suicide Screening Questions) was implemented in an urban pediatric ED for patients with psychiatric presenting complaints. Nursing compliance rates, identification of at-risk patients and sensitivity for repeated ED visits were evaluated using medical records from 970 patients. Results ASQ was implemented with a compliance rate of 79%. 53% of the patients who screened positive (237/448) did not present to the ED with suicide-related complaints. These identified patients were more likely to be male, African American and have externalizing behavior diagnoses. The ASQ demonstrated a sensitivity of 93% and specificity of 43% to predict return ED visits with suicide-related presenting complaints within six months of the index visit. Conclusions Brief suicide screening instruments can be incorporated into standard of care in pediatric ED settings. Such screens can identify patients who do not directly report suicide-related presenting complaints at triage and who may be at particular risk for future suicidal behavior. Results have the potential to inform suicide prevention strategies in pediatric EDs.

Trends in Psychiatric Emergency Department Visits Among Youth and Young Adults in the US

“…35 Surprisingly, female patients were not significantly more likely to visit the ED for suicide or selfinjury, a finding that may be partly due to the small samples sizes given the rarity of these visits. 36 This finding supports the need for suicide prevention and interventions efforts among male patients as well as female patients, who could be overlooked.…”

Predicting future self-harm or suicide in adolescents: a systematic review of risk assessment scales/tools

“…After removal of duplicate records and screening for relevance to the review, inclusion criteria were applied to 103 full-text articles. Eleven studies34–44 were included in the review and 92 excluded due to not meeting criteria for population (37 articles), study design (25), outcome (7), use of an assessment tool (15) and separately presenting data on an adolescent subgroup (8). Two of these last eight studies presented baseline, but not outcome, data for an adolescent subgroup so the authors were contacted to try to obtain these data.…”

“…The 11 included studies comprised 8 prospective35 36 38 40–44 and 3 retrospective34 37 39 cohort designs and evaluated 10 tools (table 1); eight tools were specifically for self-harm/suicide assessment and two were for hopelessness and depression. Four studies attempted to develop a prediction model 36 37 41 44.…”

“…A total of 2554 participants were included, ranging from 10 to 24 years of age who were followed up for between 3 and 18 months. Three studies contained participants that had all presented with self-harm/suicide attempt,34 36 43 and the remainder had mixed populations where >50% presented with self-harm/suicide attempt 35 37–42 44. The proportion of each study population that presented with self-harm/suicide attempt is presented in table 1.…”

Repetitive Skin Focused Disorders May Express a Functional Connectome

“…[1][2][3][4] Individuals contemplating suicide or harm to others are interfacing with health care systems that are either not recognizing those at risk or are not putting the riskiest patients in front of the clinicians with the greatest diagnostic acumen. [5][6][7] Clinicians rely on what the patient says, how they say it, and often include performance and cognitive measures to assign a diagnosis. [8][9] Many patients seen for routine medical exams have unrecognized needs for mental health care.…”