Detecting Risk of Suicide in a Pediatric Emergency Department

Adolescents Clinical Trial

Official title:

Detecting Risk of Suicide in a Pediatric Emergency Department

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00623493
• Other study ID #: 999908070
• Secondary ID: 08-M-N070
• Status: Completed
• Start date: February 7, 2008
• Est. completion date: May 30, 2018

Study information

• Verified date: May 30, 2018
• Source: National Institutes of Health Clinical Center (CC)
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

Objective:

The ultimate goal of this project is to enhance the capacity of non-mental health clinicians working in an Emergency Departments (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 in the Children s National Medical Center (CNMC) ED.

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 the CNMC ED for non-mental health reasons.

Study population:

The study population includes all patients admitted to the CNMC Emergency Department, ages 10 to 21, during the data collection weeks of the study period. Both patients admitted for mental health and non-mental health reasons will be included in the study.

Design:

This will be a prospective instrument development /validation study. During a designated study week, all mental health patients and a random subset of non-mental health patients admitted to the CNMC 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).

Description:

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).

Recruitment information / eligibility

• Status: Completed
• Enrollment: 524
• Est. completion date: May 30, 2018
• Accepts healthy volunteers: No
• Gender: All
• Age group: 10 Years to 21 Years

Eligibility

• 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)

Related Conditions & MeSH terms

• Adolescents
• Emergencies
• Mental Disorder Diagnosed in Childhood
• Mental Disorders
• Neurodevelopmental Disorders
• Psychotic Disorders
• Suicide
• Suicide Prevention

Locations

Country	Name	City	State
United States	Childrens Hospital, Boston	Boston	Massachusetts
United States	Nationwide Children's Hospital	Columbus	Ohio
United States	Childrens National Medical Center	Washington	District of Columbia

Sponsors (1)

Lead Sponsor	Collaborator
National Institute of Mental Health (NIMH)

Country where clinical trial is conducted

United States, 

References & Publications (3)

Bancroft J, Hawton K, Simkin S, Kingston B, Cumming C, Whitwell D. The reasons people give for taking overdoses: a further inquiry. Br J Med Psychol. 1979 Dec;52(4):353-65. — View Citation

Baumeister RF. Suicide as escape from self. Psychol Rev. 1990 Jan;97(1):90-113. Review. — View Citation

Bearman PS, Moody J. Suicide and friendships among American adolescents. Am J Public Health. 2004 Jan;94(1):89-95. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Positive score on suicide assessment