title: Predicting ICU admissions from attempted suicide presentations at an Emergency Department in Central Queensland.
abstract: BACKGROUND
  Emergency medicine physicians and psychiatric staff face a challenging job in risk stratifying patients presenting with suicide attempts to predict which patients need intensive care unit admission, hospital admission or can be discharged with psychiatry follow up.
  
  
  OBJECTIVE
  This study aims to analyse patients who were admitted to the intensive care unit or regular ward for suicide attempt, and the methods they employed in a rural Australian base hospital.
  
  
  METHODS
  We conducted a retrospective analysis of patients who presented with suicide attempts to the Rockhampton Base Hospital Emergency Department, Queensland Australia from 1 September 2007 to 31 August 2009. Multivariate logistic regression was undertaken to identify risk factors for ICU and regular ward admission, and predictors of suicide method.
  
  
  RESULTS
  There were 570 patients presenting with suicide attempts, 74 of which were repeat suicide attempts. There was a 10- fold increase in the odds of intensive care unit or ICU admission (CI 1.45-81.9, p=0.02) for patients who presented with drug overdose. Increased age (OR=1.02, 95 per cent CI 1.00-1.03, p=0.05), drug overdose (OR=2.69, 95 per cent CI 1.37-5.29, p=0.004), and previous suicide attempt (OR=1.53, 95 per cent CI 1.03-2.28, p=0.03) were significantly correlated with hospital admission. Male patients (OR=2.76, 95 per cent CI 1.43-5.30, p=0.002) and Aboriginal patients (OR=3.38, 95 per cent CI 1.42-8.05, p=0.006) were more likely to choose hanging as a suicide method.
  
  
  CONCLUSIONS
  We identified drug overdose as a strong predictor of ICU admission, while age, drug overdose and history of previous suicide attempts predict hospital admission. We recommend reviewing physician practices, especially safe medication, in suicide risk patients. Our study also highlights the need for continued close collaboration by acute care and community mental health providers for quality improvement.
authors.affiliation: Mount Auburn Hospital, Cambridge, USA ; Harvard Medical School, Boston, USA.
authors.forename: Xaviour
authors.initials: X
authors.lastname: Walker
authors.affiliation: Department of Anatomy, Federal University, Ndufu-Alike Ikwo. Nigeria.
authors.forename: Joon
authors.initials: J
authors.lastname: Lee
authors.affiliation: Mackay Base Hospital, Mackay, Queensland.
authors.forename: Lidia
authors.initials: L
authors.lastname: Koval
authors.affiliation: Barts and the London School of Anaesthesia, Royal London Hospital, London, UK.
authors.forename: Alana
authors.initials: A
authors.lastname: Kirkwood
authors.affiliation: Princess Alexandra Hospital, Wooloongabba, Queensland.
authors.forename: Jessica
authors.initials: J
authors.lastname: Taylor
authors.affiliation: Cairns Base Hospital, Cairns, Queensland.
authors.forename: Justin
authors.initials: J
authors.lastname: Gibbs
authors.affiliation: Redcliffe Hospital, Redcliffe, Queensland.
authors.forename: Samantha
authors.initials: S
authors.lastname: Ng
authors.affiliation: Rockhampton Base Hospital, Rockhampton, Queensland.
authors.forename: Lynne
authors.initials: L
authors.lastname: Steele
authors.affiliation: Rockhampton Base Hospital, Rockhampton, Queensland.
authors.forename: Peter
authors.initials: P
authors.lastname: Thompson
authors.affiliation: Harvard Medical School, Boston, USA ; Beth Israel Deaconess Medical Center, Boston, USA.
authors.forename: Leo Anthony
authors.initials: LA
authors.lastname: Celi
keywords: Drug Overdose; Emergency Care; Intensive Care; Suicide, Attempted; Utilisation