Pediatric emergency medicine trisk 4216 4216
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Of all screening domains, suicidality is a paramount concern for ED
clinicians. The key question is often distinguishing between self-harm and
intent to die. It should be noted, however, that previous acts of self-harm that
may not have required medical attention might also be a potent indicator of
suicide risk. An adolescent who divulges that he/she had specific plans for
suicide or a suicide attempt and a desire to kill him/herself within the past
week should be deemed imminent risk and should be considered for
psychiatric hospitalization or rapid, intense outpatient therapy. In addition,
although simply stating a belief that “life is not worth living” without having
a suicide plan rarely leads to psychiatric hospitalization, these adolescents
may still benefit from outpatient mental health services to prevent escalation
of symptoms and subsequent suicide attempts. Recent innovations have
produced efficient screening instruments and processes that can be used in
the acute care setting. The Ask Suicide Screening Questions (ASQ) and Risk
of Suicide Questionnaire (RSQ) are brief screening tools for assessing
suicidal ideation in the ED. The Behavioral Health Screen for Emergency
Departments (BHS-ED) has successfully applied computerized technology
to have adolescents self-administer suicide and depression questions, among
other behavioral health domains assessed. Any one positive answer to these
questions should prompt consultation by social worker or psychiatrist, or
referral to a crisis intervention team.
Similar developments have occurred in the real-time assessment of other
mental health domains such as traumatic stress in pediatric ED patients.
Brief screening tools for acutely injured children and their families can
assess previous adverse experiences as well as immediate response to an
acute illness and the ED visit itself. There are also resources that provide
education on what to expect, how to parent a traumatized child, how to know
when additional help is needed, and where to find it. Information such as this
can be found at sites for the National Traumatic Stress Network
( ) and the Center for Pediatric Traumatic Stress at the
Children’s Hospital of Philadelphia ( ).
Ultimately, the ED physician bears the burden of responsibility to consult
with necessary mental health and crisis professionals and make the
appropriate discharge decisions. Notably, the family’s experience in the ED
may impact the outpatient referral process. The establishment of realistic
expectations about treatment follow-up and a commitment from the
