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.
Keywords
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Article Info
Publication History
Published online: February 04, 2018
Accepted:
January 26,
2018
Received in revised form:
January 13,
2018
Received:
October 29,
2017
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
