Detecting suicide risk in a pediatric emergency department: Development ofa brief screening tool

Objective. To develop a brief screening tool that will allow emergency depa rtment (ED) staff to rapidly and accurately detect suicide risk in child an d adolescent patients. Design. Cross-sectional survey. Participants. One hundred forty-four children and adolescents, mean age of 13.6 years, presenting to an urban university teaching hospital pediatric E D for primarily psychiatric reasons. Data Collection. As part of a quality improvement initiative, we developed a 14-item screening survey (the Risk of Suicide Questionnaire [RSQ]) that w as administered by a triage nurse to all pediatric mental health patients o n admission to the ED. All patients were subsequently administered the 30-i tem Suicide Ideation Questionnaire (SIQ) by a mental health clinician, whic h served as the criterion standard assessment of suicidality. Other informa tion collected included demographic and clinical characteristics. Main Outcome Measures. Sensitivity, specificity, positive predictive value, negative predictive value (NPV), and area under the receiver operating cha racteristic curve for responses to individual and combinations of RSQ items , relative to determinations of suicidality by the criterion standard SIQ. Results. Four of the items from the RSQ had a predictive c statistic of 0.8 7, a sensitivity of 0.98, and a NPV of 0.97. Little improvement in predicti ve ability was obtained by including other RSQ items (c statistic for the m ost predictive 4-item model = 0.87; c statistic for the model containing al l 14 items = 0.90). Among all possible combinations of 4 RSQ items, the com bination of items inquiring about current suicidal behavior, past suicidal ideation, past self-destructive behavior, and current stressors yielded the highest sensitivity (0.98), NPV (0.97), and c statistic (0.87), as assesse d by the criterion standard SIQ. Conclusions. A brief 4-item screening tool can be used by nonmental health clinicians to accurately detect suicidality in children and adolescents who visit an ED. Early and accurate identification of suicidality is a critica l first step that could lead to better treatment and improved health outcom es for children and adolescents with mental health concerns.