Suicide screening tools and their association with near-term adverse events in the ED

OBJECTIVES:
The goal of this study was to evaluate the relationship between various suicide screening tools and clinical impression with subsequent patient psychiatric admission and near-term adverse emergency department (ED) events.

METHODS:
We performed a prospective observational study of 50 patients with suicidal ideation in the ED. Subjects completed a series of depression/suicide screening tools: the Columbia Suicide Severity Scale, SAD PERSONS scale, Patient Health Questionnaire 9, and Beck Scale for Suicidal Ideation. Clinicians were also asked about their impression on likelihood of patient admission. Outcome measures were as follows: need for psychiatric hospital admission, prolonged stay at psychiatric facility, and any adverse events during ED stay including need for unscheduled psychiatric or sedating medications, need for physical restraints, and need for intervention by security staff.

RESULTS:
The Beck Scale for Suicidal Ideation, Patient Health Questionnaire 9, and Columbia Suicide Severity Scale did not significantly predict within-ED adverse events or admissions to psychiatric facilities. Wald test for individual parameters at an α of .10 level found that patients who were screened positive by their nurse had 3.37 times the odds of adverse within-ED events; patients with a positive SAD PERSONS score had 8.18 times the odds of psychiatric admission greater than 5 days. However, at the α of .05 level, no screening tools correlated with patient ED course or likelihood of psychiatric admission.

CONCLUSION:
Clinical impression alone and the suicide screening tools showed poor predictive value for near-term events. Data from this study highlight the need for the development of ED-based suicide screening instruments capable of identifying those patients with suicidal ideation at greatest risk.