Risk Assessment Associated with Suicidal Ideation in the Pediatric Emergency Department Utility of an Adult-Verified Risk Assessment Tool

Objectives: The Substance Abuse and Mental Health Services Administration and the Suicide Prevention Resource Center created a guide for suicide risk assessment in adult emergency departments (EDs). We compared the findings of that decision support tool with those of pediatric psychiatrists' evaluations for risk stratification of pediatric ED admissions due to suicidal ideation. Methods The medical records of all 5- to 18-year-olds who presented to a pediatric ED due to suicidal ideation between May 2017 and January 2020 were reviewed. We used the 6-item decision support tool to retrospectively calculate and define "low" and "high" risk of attempting suicide. The recorded findings of psychiatric assessments and recommendations for management were retrieved. Results A total of 297 cases were included. The decision support tool calculated that 93 (31%) were low risk and 204 (69%) were high risk. Eighty-eight of the 93 low-risk patients (94.6%) were discharged home with follow-up instructions by a pediatric psychiatrist, and 5 of the 205 high-risk patients (5.4%) were admitted to an inpatient psychiatric ward for further observation. The remaining 199 high-risk patients were discharged home following psychiatric assessment with instructions to refer to mental health services follow-up Conclusion A decision support tool shows promise to assist the pediatric emergency physician in differentiating between low-risk youngsters presenting with suicidal ideation who may be safely discharged home with an appropriate follow-up plan and high-risk youngsters who require inpatient psychiatric observation. The tool may reduce the burden resulting from the expenditure of time and resources of a psychiatric evaluation in the ED. Prospective studies with follow-up are warranted to confirm its utility.