SGEM#252: Blue Monday- Screening Adult ED Patients for Risk of Future Suicidality

Date: April 11th, 2019 Reference: Brucker et al. Assessing Risk of Future Suicidality in Emergency Department Patients. AEM April 2019 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the excellent #FOAMed project called First10EM.com WARNING: This SGEM episode discusses suicide. This is a warning to those listening to the podcast or reading the blog post. The SGEM is free and open access initiative trying to cut the knowledge translation down from over ten years to less than one year. It is intended for clinicians providing care to emergency patients, so they get the best care, based on the best evidence. If you are feeling upset by the content, then please stop listening or reading. There will be resources listed at the end of the blog for those looking for assistance. Case: A 32-year-old woman presents to the emergency department after spraining her ankle playing basketball. Although she has no other health problems, and no other complaints, you are aware of data that indicates there is a high level of psychiatric illness and suicidal ideation among emergency department patients and wonder what is the best way to approach this problem? Background: Suicidal ideation is common; it accounts for about 1% of emergency department visits, or about 1.4 million visits a year in the United States [1]. Although there are numerous validated screening tools, such as the PHQ9, the ED-Safe Patient Safety Screener, and the Suicide Behaviors Questionnaire–Revised (SBQ-R), none have been tested against physician gestalt, and none are widely used in clinical practice [2,3,4]. The Convergent Functional Information for Suicidality (CFI-S) is a validated screening tool for suicidal ideation, but it has not been tested in an emergency department (ED) setting [5,6]. The current trial aimed at assessing the accuracy of the CFI-S in the ED, while comparing it to a screening tool already in use and physician gestalt [7].  Clinical Question: Can the CFI-S improve on clinician gestalt for screening of all adults to an emergency department for suicidal ideation? Reference: Brucker et al. Assessing Risk of Future Suicidality in Emergency Department Patients. AEM April 2019 Population: Adult patients presenting to the emergency department, without regard to the chief complaint. Exclusions: Severe trauma or illness requiring emergent intervention or acute intoxication. Intervention: The Convergent Functional Information for Suicidality (CFI-S) screening tool Comparison: Physician gestalt Outcomes: Any suicidality spectrum event in the six months after the ED visit. This was defined as a repeat ED visit or admission for suicidal ideation, preparatory acts, suicide attempts, aborted or interrupted attempts, or completed suicide. Dr. Krista Brucker This is an SGEMHOP episode which means we have the lead author on the show. Dr. Krista Brucker is an emergency physician in South Bend, IN. With the help of a dedicated team of medical students and some very patient mentors, Dr. Brucker completed this work while she was an assistant professor of emergency medicine at Indiana University school of Medicine. Authors’ Conclusions: “Using CFI-S, or some of its items, in busy EDs may help improve the detection of patients at high risk for future suicidality.” Quality Checklist for a Prognostic Study:  The study population included or focused on those in the emergency department? Yes The patients were representative of those with the problem? Unsure The patients were sufficiently homogenous with respect to prognostic risk? Unsure Objective and unbiased outcome criteria were used? No The follow-up was sufficiently long and complete? No The effect was large enough and precise enough to be clinically significant? No Key Results: A total of 367 patients were approach and 338 agreed to participate in the study.