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Suicide screening scales may not adequately predict disposition of suicidal patients from the emergency department

  • Samuel Mullinax
    Correspondence
    Corresponding author at: Department of Emergency Medicine, University of Arkansas for Medical Sciences, 4301 West Markham Street, #584, Little Rock, AR 72205-7199, United States.
    Affiliations
    Department of Emergency Medicine Behavioral Emergences Research (DEMBER) lab, 4301 West Markham St, #584, Little Rock, AR 72205, United States
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  • Christen E. Chalmers
    Affiliations
    Department of Emergency Medicine Behavioral Emergences Research (DEMBER) lab, 4301 West Markham St, #584, Little Rock, AR 72205, United States
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  • Jesse Brennan
    Affiliations
    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
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  • Gary M. Vilke
    Affiliations
    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
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  • Kimberly Nordstrom
    Affiliations
    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
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  • Michael P. Wilson
    Affiliations
    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
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Published:February 04, 2018DOI:https://doi.org/10.1016/j.ajem.2018.01.087

      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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