PEDIATRICS Vol. 107 No. 5 May 2001, pp. 1133-1137

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

Received Jun 30 2000; accepted Dec 11, 2000.

Lisa M. Horowitz^*, , Philip S. Wang^§, , Gerald P. Koocher^*, Barbara H. Burr^*, Mary Fallon Smith^¶, Susan Klavon, and Paul D. Cleary

From the ^* Department of Psychiatry, Children's Hospital/Harvard Medical School, Boston, Massachusetts; the  Department of Quality Improvement, Children's Hospital/Harvard Medical School, Boston, Massachusetts; the ^§ Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts; the  Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts; and the ^¶ Emergency Department, Children's Hospital/Harvard Medical School, Boston, Massachusetts.

Objective.  To develop a brief screening tool that will allow emergency department (ED) staff to rapidly and accurately detect suicide risk in child and adolescent patients.

Design.  Cross-sectional survey.

Participants.  One hundred forty-four children and adolescents, mean age of 13.6 years, presenting to an urban university teaching hospital pediatric ED for primarily psychiatric reasons.

Data Collection.  As part of a quality improvement initiative, we developed a 14-item screening survey (the Risk of Suicide Questionnaire [RSQ]) that was administered by a triage nurse to all pediatric mental health patients on admission to the ED. All patients were subsequently administered the 30-item Suicide Ideation Questionnaire (SIQ) by a mental health clinician, which served as the criterion standard assessment of suicidality. Other information collected included demographic and clinical characteristics.

Main Outcome Measures.  Sensitivity, specificity, positive predictive value, negative predictive value (NPV), and area under the receiver operating characteristic curve for responses to individual and combinations of RSQ items, relative to determinations of suicidality by the criterion standard SIQ.

Results.  Four of the items from the RSQ had a predictive c statistic of 0.87, a sensitivity of 0.98, and a NPV of 0.97. Little improvement in predictive ability was obtained by including other RSQ items (c statistic for the most predictive 4-item model = 0.87; c statistic for the model containing all 14 items = 0.90). Among all possible combinations of 4 RSQ items, the combination of items inquiring about current suicidal behavior, past suicidal ideation, past self-destructive behavior, and current stressors yielded the highest sensitivity (0.98), NPV (0.97), and c statistic (0.87), as assessed by the criterion standard SIQ.

Conclusions.  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.  Key words:  suicidal behavior, suicidal ideation, screening tool, emergency medicine, suicide risk, children, adolescents.

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				V. N. Folse and R. L. Hahn Suicide Risk Screening in an Emergency Department: Engaging Staff Nurses in Continued Testing of a Brief Instrument Clin Nurs Res, August 1, 2009; 18(3): 253 - 271. [Abstract] [PDF]

				C Dieppe, B Stanhope, and K Rakhra Children who harm themselves: development of a paediatric emergency department triage tool Emerg. Med. J., June 1, 2009; 26(6): 418 - 420. [Abstract] [Full Text] [PDF]

				L. Horowitz, N. Kassam-Adams, and J. Bergstein Mental Health Aspects of Emergency Medical Services for Children: Summary of a Consensus Conference J. Pediatr. Psychol., December 1, 2001; 26(8): 491 - 502. [Abstract] [Full Text] [PDF]

eLetters: