Prevention Science

, Volume 18, Issue 2, pp 174–182 | Cite as

Identification of At-Risk Youth by Suicide Screening in a Pediatric Emergency Department

  • Elizabeth D. BallardEmail author
  • Mary Cwik
  • Kathryn Van Eck
  • Mitchell Goldstein
  • Clarissa Alfes
  • Mary Ellen Wilson
  • Jane M. Virden
  • Lisa M. Horowitz
  • Holly C. Wilcox


The pediatric emergency department (ED) is a critical location for the identification of children and adolescents at risk for suicide. Screening instruments that can be easily incorporated into clinical practice in EDs to identify and intervene with patients at increased suicide risk is a promising suicide prevention strategy and patient safety objective. This study is a retrospective review of the implementation of a brief suicide screen for pediatric psychiatric ED patients as standard of care. The Ask Suicide Screening Questions (ASQ) was implemented in an urban pediatric ED for patients with psychiatric presenting complaints. Nursing compliance rates, identification of at-risk patients, and sensitivity for repeated ED visits were evaluated using medical records from 970 patients. The ASQ was implemented with a compliance rate of 79 %. Fifty-three percent of the patients who screened positive (237/448) did not present to the ED with suicide-related complaints. These identified patients were more likely to be male, African American, and have externalizing behavior diagnoses. The ASQ demonstrated a sensitivity of 93 % and specificity of 43 % to predict return ED visits with suicide-related presenting complaints within 6 months of the index visit. Brief suicide screening instruments can be incorporated into standard of care in pediatric ED settings. Such screens can identify patients who do not directly report suicide-related presenting complaints at triage and who may be at particular risk for future suicidal behavior. Results have the potential to inform suicide prevention strategies in pediatric EDs.


Suicide Emergency department Screening Pediatrics 


Compliance with Ethical Standards


This study was supported in part by an award from the Garrett Lee Smith grant U79SM061751 from the Substance Abuse and Mental Health Services Administration (SAMHSA). The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

Ethical Approval

The Johns Hopkins University School of Medicine Institutional Review Board approved this medical record review of data collected as standard of care. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

For this type of study, formal consent is not required.


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Copyright information

© Society for Prevention Research (outside the USA) 2016

Authors and Affiliations

  • Elizabeth D. Ballard
    • 1
    Email author
  • Mary Cwik
    • 2
    • 3
  • Kathryn Van Eck
    • 4
    • 5
  • Mitchell Goldstein
    • 5
  • Clarissa Alfes
    • 2
  • Mary Ellen Wilson
    • 6
  • Jane M. Virden
    • 6
  • Lisa M. Horowitz
    • 7
  • Holly C. Wilcox
    • 2
    • 4
  1. 1.Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental HealthNational Institutes of HealthBethesdaUSA
  2. 2.Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Center for American Indian HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  4. 4.Department of Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  5. 5.Department of PediatricsJohns Hopkins University School of MedicineBaltimoreUSA
  6. 6.Pediatric Emergency DepartmentThe Johns Hopkins HospitalBaltimoreUSA
  7. 7.Office of the Clinical Director, Intramural Research Program, National Institute of Mental HealthNational Institutes of HealthBethesdaUSA

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