Assessing Risk of Future Suicidality in Emergency Department Patients.

Area of Science:

• Emergency medicine
• Psychiatry
• Public health

Background:

• Emergency departments (EDs) manage patients at risk for crisis and suicidality.
• Current triage methods may miss individuals who later exhibit suicidal behavior.
• The Convergent Functional Information for Suicidality (CFI-S) checklist has shown predictive ability in psychiatric patients but needed validation in ED settings.

Purpose of the Study:

• To evaluate the predictive ability of the CFI-S checklist in a real-world emergency department (ED) setting.
• To compare the diagnostic accuracy of CFI-S with standard suicide clinical screening (SCS) and physician gestalt assessment.

Main Methods:

• Prospective administration of the CFI-S checklist to consecutive ED patients.
• Inclusion of standard ED suicide clinical screening (SCS) and physician visual analog scale (VAS) assessments.
• Six-month follow-up via chart review and telephone to identify suicidality spectrum events (SSEs).

Main Results:

• The CFI-S checklist was completed in a median of 3 minutes.
• Of 338 patients, 13.3% screened positive on SCS, and 9.5% experienced a SSE within 6 months.
• CFI-S demonstrated the highest diagnostic accuracy (AUC = 0.81) compared to SCS (modest accuracy) and physician VAS (moderate accuracy).
• Key differentiating CFI-S items included psychiatric illness, perceived uselessness, and social isolation.

Conclusions:

• The CFI-S checklist, or selected items, can enhance the identification of high-risk patients for future suicidality in busy EDs.
• Implementing CFI-S may improve patient safety and outcomes in emergency care settings.