Pediatric Resident University of Louisville University of Louisville Louisville, Kentucky, United States
Background: Suicide is the second leading cause of death in people aged 10-24. Despite how common it is suicide screening is not universal during healthcare encounters. No studies have been conducted to examine universal suicide screening in a pediatric emergency department (ED).
Objective: To assess the effectiveness of universal suicide screening in a pediatric ED.
Design/Methods: Since 4/7/2019, all patients age 10 and over who present to the pediatric ED of our urban, tertiary care, freestanding children’s hospital are screened with the validated Columbia Suicide Severity Rating Scale (C-SSRS, figure 1) and categorized as mild, moderate or severe risk for suicide. Children who screen moderate or severe are automatically evaluated by mental health providers after being medically cleared. Screenings from April 2019 through December 2019 were reviewed by investigators. All children aged 10-18 who were screened were included. Data collected included name, age, DOB, gender, race, ethnicity, number of visits to the ED the year prior to presentation, past chief complaints (CC), suicidal ideation, suicide attempt, and disposition. Statistical analysis was performed using SPSS version 26.
Results: A total of 11,469 subjects were screened for suicide risk during the study period. Of those screened, 340 were positive on C-SSRS. Of these, 5 were excluded for being outside of the age range. Of the remaining 335 subjects who screened positive 116 (34.5)% of them presented with a medical chief complaint rather than a psychiatric one. 120 subjects screened mild risk (35.8%), 46 were moderate (13.7%), and 169 were severe (50.4%). Psychiatric admission rates by severity are seen in figure 2. Additional breakdown of this data is in table 1. In total 141 positive subjects were admitted for mental health concerns and, of these, 85 subjects (60.3%) had no previous psychiatric compliant or prior ED visit. A total of 242 positive subjects had at least 1 ED visit in the year prior to presentation, 116 (47.9%) of these were admitted. Conclusion(s): A significant number of patients who screened positive did not present with a psychiatric concern. Moreover, nearly half of screen positive children who were admitted for mental health concerns had been seen in the ED in the year prior to their visit, mostly before the screening process rollout. Initiation of universal suicide screening in the pediatric ED identified a significant number of children with unrecognized suicide risk.
Admission rates by C-SSRS severity
C-SSRS positive admission breakdown and additional data
Authors/Institutions: Esper Wadih, University of Louisville, Louisville, Kentucky, United States; Dawson Willis, University of Louisville, Louisville, Kentucky, United States; Kerry Caperell, University of Louisville, Louisville, Kentucky, United States