Risk Assessment Following Suicidal Ideation in the Pediatric Emergency Department: Comparison of a Risk Assessment Tool with a Psychiatrist’s Evaluation

Suicide is a major public health concern and the second leading cause of death in youths in
developed countries. The purpose of this study was to compare the
risk evaluation performed by the pediatric psychiatrist in the ED to risk assessment according to a
decision support tool. This retrospective cohort study reviewed all cases of patients 5-18 years old
who presented to the Dana-Dwek Children`s Hospital ED due to SI between May 1st, 2017 and
January 31st, 2020. The Six-item decision support tool (SPRC/SAMHSA Decision Support Tool) was
implemented on all cases. In total 297 cases were included in the study. Nearly half of the patients
(138, 46%) were referred to the ED by the education system. When using the SPRC/SAMHSA
Decision Support Tool to calculate the score for all patients, 93 (31%) were low risk (score = 0) and
204 (69%) were high risk. Five of the low risk cases (5.4%) and 85/204 high risk patients (42%)
resulted in hospitalization (P < 0.0001). Various factors were noted to be influencers on the decision
to admit. Mental health evaluations of children and adolescents presenting to the pediatric ED due to
SI should include a focused medical assessment and a suicide risk assessment, which can help providers
determine if a psychiatrist’s consultation is required and if the patient needs hospitalization.
The SPRC/SAMHSA Decision Support Tool may assist the ED pediatrician in identifying low risk
patients, who may be discharged safely home, once a proper follow up plan is in place. Further
prospective studies with follow up are needed to assess this method.