Detecting Risk of Suicide in a Pediatric Emergency Department

Objective:

The ultimate goal of this project is to enhance the capacity of non-mental health clinicians
working in an Emergency Department (ED) to recognize and initiate further evaluation of
children and adolescents at risk for suicide.

- Aim 1: To re-validate the Risk of Suicide Questionnaire (RSQ), a screening tool that
assists non-psychiatric clinicians in rapidly detecting suicide risk in pediatric
patients, in a pediatric ED mental health population.

- Aim 2: To determine the utility of a suicide screening tool, a revised version of the
Risk of Suicide Questionnaire, to detect suicide risk in pediatric patients presenting
to a pediatric ED for non-mental health reasons.

Study population:

This is a multi-site study and will include all patients admitted to three pediatric EDs (the
Children s National Medical Center (CNMC) ED, Children s Hospital Boston (CHB) ED, and
Nationwide Children s Hospital (NCH) ED), ages 10 to 21, during the data collection days of
the study period. Both patients admitted for mental health and non-mental health reasons will
be included in the study.

For ease of reading, from here on in, the three pediatric EDs participating in this
multi-site study will be referred to as the PEDIATRIC ED.

Design:

This will be a prospective instrument development / validation study. During 5 to 10 weekdays
of the month, all mental health patients and a random subset of non-mental health patients
admitted to the PEDIATRIC ED will be approached after their triage assessment. Following
informed consent and assent, a 17-item suicide assessment tool created for this research
project (RSQ-Revised), as well as a brief background questionnaire will be administered.
These questions will be validated against a gold standard suicide assessment questionnaire,
which will be administered to the subjects directly after the RSQ-Revised. The study aims to
develop a brief suicide screening tool to be used at triage for all patients entering the ED.

Measures

Measures include the proposed 17-item screening questionnaire and a gold standard assessment
of suicidal ideation in adolescents, the Suicide Ideation Questionnaire (SIQ).

- INCLUSION CRITERIA:

Patient must complete triage assessment at the PEDIATRIC ED.

For the medical patients, triage level must be 2, 3, 4 or 5, and the patient must be
medically stable. For medical patients in triage level 2, in order to determine if the
patient is medically stable, the interviewer will contact the ED clinician (nurse or
physician) prior to approaching the patient. Any patient deemed medically unstable will not
be included in the study. For the psychiatric patients, leveling is not conducted in the
same way. Therefore, triage level will not be considered an exclusion factor.

Triage level in the PEDIATRIC EDs is defined by the Emergency Severity Index (ESI). ESI is
a five-level ED triage algorithm that uses acuity and resource needs to stratify patients
into five clinically relevant groups from 1 (most urgent) to 5 (least urgent) (Gilboy,
2005).

Age: 10-21 years.

English speaking

A legal guardian must provide informed consent and patient must sign an assent document.

EXCLUSION CRITERIA:

Developmental disability, severe cognitive impairment or communication disorder such that
patient will not be able to comprehend the questions or communicate their answers

Triage level of 1 (for medical patients), indicating that the patient is not medically
stable

Patient is not present with a legal guardian who can provide informed consent

Patient is non-English speaking (unfortunately, the SIQ is not available at this time in
Spanish or any other languages)