Association of positive responses to suicide screening questions with hospital admission and repeated emergency department visits in children and adolescents.
OBJECTIVE
Although validated suicide screening tools exist for use among children and adolescents presenting to emergency departments (EDs), the associations between screening positive for suicide risk and immediate psychiatric hospital admission or subsequent ED use, stratified by age, have not been examined.


METHODS
This is a retrospective cohort study of a consecutive case series of patients aged 8 to 18 years presenting with psychiatric chief complaints during a 9-month period to a single urban tertiary care pediatric ED. Eligible patients were administered a subset of questions from the Risk of Suicide Questionnaire. Outcomes included the odds of psychiatric hospitalization at the index visit and repeated ED visits for psychiatric complaints within the following year, stratified by age.


RESULTS
Of the 568 patients presenting during the study period, responses to suicide screening questions were available for 442 patients (78%). A total of 159 (36%) of 442 were hospitalized and 130 (29%) of 442 had 1 or more ED visits within the following year. The proportion of patients providing positive responses to 1 or more suicide screening questions did not differ between patients aged 8 to 12 years and those aged 13 to 18 years (77/154 [50%] vs 137/288 [48%], P = 0.63). A positive response to 1 or more of the questions was significantly associated with increased odds of psychiatric hospitalization in the older age group [adjusted odds ratio, 3.82; 95% confidence interval, 2.24-6.54) and with repeated visits to the ED in the younger age group (adjusted odds ratio, 3.55 95% confidence interval, 1.68-7.50).


CONCLUSIONS
Positive responses to suicide screening questions were associated with acute psychiatric hospitalization and repeated ED visits. Suicide screening in a pediatric ED may identify children and adolescents with increased need of psychiatric resources.
From the *Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore; and †National Institute of Mental Health, NIH, Bethesda, MD; ‡Department of Psychology, The Catholic University of America; and §Division of Emergency Medicine, Children's National Medical Center, Washington, DC.
Elizabeth D
ED
Ballard
Lisa M
LM
Horowitz
David A
DA
Jobes
Barry M
BM
Wagner
Maryland
M
Pao
Stephen J
SJ
Teach
D000293:Adolescent; D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data; D000367:Age Factors; D002648:Child; D004219:District of Columbia / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008403:Mass Screening; D016017:Odds Ratio; D010343:Patient Admission; D010359:Patient Readmission; D012189:Retrospective Studies; D016728:Self-Injurious Behavior; D012680:Sensitivity and Specificity; D013315:Stress, Psychological; D059020:Suicidal Ideation; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D014505:Urban Population / Q000706:statistics & numerical data; D000092864:Suicide Prevention