Identification of At-Risk Youth by Suicide Screening in a Pediatric Emergency Department.
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. The Ask Suicide Screening Questions (ASQ) 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. The ASQ was implemented with a compliance rate of 79 %. Fifty-three percent 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 6 months of the index visit. 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.
Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Building 10, CRC Room 7-3345, MSC 1282, Bethesda, MD, 20892, USA. Elizabeth.Ballard@nih.gov.
Elizabeth D
ED
Ballard
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Mary
M
Cwik
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.|Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Kathryn
K
Van Eck
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Mitchell
M
Goldstein
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Clarissa
C
Alfes
Pediatric Emergency Department, The Johns Hopkins Hospital, Baltimore, MD, USA.
Mary Ellen
ME
Wilson
Pediatric Emergency Department, The Johns Hopkins Hospital, Baltimore, MD, USA.
Jane M
JM
Virden
Office of the Clinical Director, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
Lisa M
LM
Horowitz
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Holly C
HC
Wilcox
D000293:Adolescent; D004636:Emergency Service, Hospital; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D059020:Suicidal Ideation; D055815:Young Adult; D000092864:Suicide Prevention
Emergency department; Pediatrics; Screening; Suicide
Psychiatr Serv. 2001 Jun;52(6):828-33
11376235
Pediatrics. 2001 May;107(5):1133-7
11331698
Pediatr Emerg Care. 2015 Aug;31(8):555-9
25834957
Gen Hosp Psychiatry. 2012 Sep-Oct;34(5):557-65
22554432
Gen Hosp Psychiatry. 2009 Nov-Dec;31(6):501-2
19892206
J Psychiatr Res. 2014 Nov;58:123-8
25124549
Arch Pediatr Adolesc Med. 2000 Apr;154(4):361-5
10768673
Pediatr Emerg Care. 2009 Apr;25(4):217-20
19382317
Arch Pediatr Adolesc Med. 2012 Dec;166(12):1170-6
23027429
J Dev Behav Pediatr. 2012 Jun;33(5):431-40
22668827
Soc Psychiatry Psychiatr Epidemiol. 2012 Jan;47(1):29-42
21153018
Clin Nurs Res. 2009 Aug;18(3):253-71
19411625
JAMA Pediatr. 2015 Jul;169(7):673-7
25984947
J Clin Nurs. 2007 Sep;16(9):1704-11
17459135
Pediatr Emerg Care. 2009 Nov;25(11):715-20
19864967
J Abnorm Child Psychol. 2014;42(3):467-77
23996157
Am Psychol. 2008 Jan;63(1):14-31
18193978
Am J Psychiatry. 2004 Mar;161(3):562-3
14992984
Am J Prev Med. 2014 Sep;47(3 Suppl 2):S163-9
25145734
Autism Res. 2014 Aug;7(4):507-21
24798640
J Clin Child Adolesc Psychol. 2015;44(1):194-203
25255931
J Am Acad Child Adolesc Psychiatry. 2012 Feb;51(2):213-222.e1
22265367
Biol Psychiatry. 2009 Apr 1;65(7):556-63
19201395
Pediatr Emerg Care. 2012 Sep;28(9):835-41
22929135
Sentinel Event Alert. 2016 Feb 24;(56):1-7
26915165
Acad Emerg Med. 2009 Nov;16(11):1234-41
19845554
Psychiatr Serv. 2015 Jan 1;66(1):97-100
25321886
Curr Opin Pediatr. 2009 Oct;21(5):620-7
19617829
Crisis. 2010;31(1):1-6
20197251
J Black Psychol. 2006 Aug;32(3):366-389
17080183
J Child Adolesc Psychopharmacol. 2015 Mar;25(2):100-8
25746114