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ED recommendations for suicide prevention in adults: The ICAR2E mnemonic and a systematic review of the literature

      Abstract

      Introduction

      Caring for suicidal patients can be challenging, especially in emergency departments without easy access to mental health specialists. The American College of Emergency Physicians and the American Foundation for Suicide Prevention appointed a working group to create an easy-to-use suicide prevention tool for ED providers.

      Methods

      The writing group created an easy-to-use mnemonic for the care of adult patients as a way of organizing sequential steps, accompanied by a systematic review of available ED-based suicide prevention literature. The systematic review was performed both to ensure that all relevant evidence was taken into account as well as to evaluate the strength of evidence for each recommendation. Levels of evidence were assigned utilizing the ACEP level of evidence classification.

      Results

      The writing group created the mnemonic ICAR2E, which stands for Identify suicide risk; Communicate; Assess for life threats and ensure safety; Risk assessment (of suicide); Reduce the risk (of suicide); and Extend care beyond the ED. 31 articles were identified in the search, and were included in the systematic review.

      Conclusions

      The ICAR2E mnemonic may be a feasible way for practicing ED clinicians to provide evidence-based care to suicidal patients. However, further research is needed.

      Keywords

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      Linked Article

      • Suicide and the creation of evidence-based guidelines: the ACEP perspective
        The American Journal of Emergency MedicineVol. 37Issue 12
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          The American College of Emergency Physicians, as well as most emergency physicians, recognize that suicide is a national epidemic [1]. Suicide is the 10th leading cause of death for all ages combined [1], and from 1999 to 2016, suicide rates rose by 28% nationally [2]. Most patients have seen a physician prior to their suicide [3,4], and many of these patients have seen this physician in the emergency department (ED) [5-7]. In fact, “mental disorders” was the 9th leading diagnosis made in emergency department patients in 2015 [8].
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