Samuel Mullinax1, Christen E Chalmers2, Jesse Brennan3, Gary M Vilke3, Kimberly Nordstrom4, Michael P Wilson5. 1. Department of Emergency Medicine Behavioral Emergences Research (DEMBER) lab, 4301 West Markham St, #584, Little Rock, AR 72205, United States. Electronic address: smmllnx@gmail.com. 2. Department of Emergency Medicine Behavioral Emergences Research (DEMBER) lab, 4301 West Markham St, #584, Little Rock, AR 72205, United States. 3. Department of Emergency Medicine Behavioral Emergences Research (DEMBER) lab, 4301 West Markham St, #584, Little Rock, AR 72205, United States; Department of Emergency Medicine, UC San Diego Health System, University of California San Diego, 200 W Arbor Dr, San Diego, CA 92103, United States. 4. Department of Emergency Medicine Behavioral Emergences Research (DEMBER) lab, 4301 West Markham St, #584, Little Rock, AR 72205, United States; Office of Behavioral Health, State of Colorado, 3824 W Princeton Cir, Denver, CO 80236, United States; Department of Psychiatry, University of Colorado at Denver, 1201 Larimer St, Denver, CO 80204, United States. 5. Department of Emergency Medicine Behavioral Emergences Research (DEMBER) lab, 4301 West Markham St, #584, Little Rock, AR 72205, United States; Department of Emergency Medicine, University of Arkansas for Medical Sciences, 4301 West Markham St, #584, Little Rock, AR 72205, United States.
Abstract
BACKGROUND: Suicide screening scales have been advocated for use in the ED setting. However, it is currently unknown whether patients classified as low-risk on these scales can be safely discharged from the emergency department. This study evaluated the utility of three commonly-used suicide screening tools in the emergency department to predict ED disposition, with special interest in discharge among low-risk patients. METHODS: This prospective observational study enrolled a convenience sample of patients who answered "yes" to a triage suicidal ideation question in an urban academic emergency department. Patients were administered the weighted modified SADPERSONS Scale, Suicide Assessment Five-step Evaluation and Triage, and Columbia-Suicide Severity Rating Scale. Patients who subsequently received a psychiatric evaluation were included, and the utility of these screening tools to predict disposition was evaluated. RESULTS: 276 subjects completed all three suicide screening tools and were included in data analyses. Eighty-two patients (30%) were admitted or transferred. Three patients (1%) died by suicide within one year of enrollment; one was hospitalized at the end of his or her enrollment visit, dying by suicide seven months later and the other two were discharged, dying by suicide nine and ten months later, respectively. The screening tools exhibited modest negative predictive values (range: 0.66-0.73). CONCLUSION: Three suicide screening tools displayed modest ability to predict the disposition of patients who presented to an emergency department with suicidal ideation. This study supports the current ACEP clinical policy on psychiatric patients which states that screening tools should not be used in isolation to guide disposition decisions of suicidal patients from the ED.
BACKGROUND: Suicide screening scales have been advocated for use in the ED setting. However, it is currently unknown whether patients classified as low-risk on these scales can be safely discharged from the emergency department. This study evaluated the utility of three commonly-used suicide screening tools in the emergency department to predict ED disposition, with special interest in discharge among low-risk patients. METHODS: This prospective observational study enrolled a convenience sample of patients who answered "yes" to a triage suicidal ideation question in an urban academic emergency department. Patients were administered the weighted modified SADPERSONS Scale, Suicide Assessment Five-step Evaluation and Triage, and Columbia-Suicide Severity Rating Scale. Patients who subsequently received a psychiatric evaluation were included, and the utility of these screening tools to predict disposition was evaluated. RESULTS: 276 subjects completed all three suicide screening tools and were included in data analyses. Eighty-two patients (30%) were admitted or transferred. Three patients (1%) died by suicide within one year of enrollment; one was hospitalized at the end of his or her enrollment visit, dying by suicide seven months later and the other two were discharged, dying by suicide nine and ten months later, respectively. The screening tools exhibited modest negative predictive values (range: 0.66-0.73). CONCLUSION: Three suicide screening tools displayed modest ability to predict the disposition of patients who presented to an emergency department with suicidal ideation. This study supports the current ACEP clinical policy on psychiatricpatients which states that screening tools should not be used in isolation to guide disposition decisions of suicidal patients from the ED.
Authors: Anne C Knorr; Brooke A Ammerman; Sean A LaFleur; Debdipto Misra; Mathrawala A Dhruv; Bipin Karunakaran; Robert J Strony Journal: J Am Coll Emerg Physicians Open Date: 2020-05-25