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Assessment of suicide potential by nonpsychiatrists using the SAD PERSONS score
R S Hockberger1, R J Rothstein
1UCLA School of Medicine, Department of Emergency Medicine, Torrance 90509.
Abstract:
We were unable to validate the predictive ability of a previously described mneumonic (SAD PERSONS score, SPS) for determining the need for hospitalization of patients who have expressed suicidal ideation or behavior. After reviewing published studies on the subject, we arrived at a modification of this scale (MSPS). The MSPS obtained by nonpsychiatric and psychiatric house staff was compared and correlated with patient disposition for 100 consecutive adult patients presenting to the Harbor-UCLA Medical Center emergency department for the assessment of suicidal behavior. We were unable to correlate the MSPS with patient disposition. However, four criteria were found to correlate with the need for hospitalization (P less than .001). After weighting the MSPS, giving two points for each of these four criteria, and one point for each of the other six, we found that a score of greater than or equal to 6 had a sensitivity of 94% and a specificity of 71% in identifying need for hospitalization. A score of less than or equal to 5 had a negative predictive value for hospitalization of 95%. When two nonsuicidal patients, admitted for situational reasons only, were eliminated, a score of greater than or equal to 6 had a 100% sensitivity and a score of less than or equal to 5 had a 100% negative predictive value in identifying patients requiring hospitalization. Subsequent use of the weighted MSPS for an additional 82 patients confirmed these results. Follow-up of 97.5% (116/119) of all patients discharged from the emergency department at 6 to 12 months found no mortalities. Using a weighted MSPS, nonpsychiatrists can quickly and easily obtain the objective information necessary to make an initial assessment of suicidality.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
A modified SAD PERSONS score (MSPS) effectively identifies patients needing hospitalization for suicidal ideation. This validated tool aids nonpsychiatrists in rapid, objective suicidality assessment, improving patient care and reducing hospital admissions for low-risk individuals.
Area of Science:
- Psychiatry
- Emergency Medicine
- Public Health
Background:
- The SAD PERSONS score (SPS) is a mnemonic used to assess the need for hospitalization in patients with suicidal ideation.
- Previous validation studies have shown limitations in the predictive ability of the original SPS.
- Accurate assessment of suicidality in emergency departments is crucial for patient safety and resource allocation.
Purpose of the Study:
- To validate the predictive ability of a modified SAD PERSONS score (MSPS) for hospitalization decisions.
- To identify key criteria correlating with the need for inpatient psychiatric care.
- To develop a refined tool for objective suicidality assessment by nonpsychiatric clinicians.
Main Methods:
- A modified SAD PERSONS score (MSPS) was developed based on a review of existing literature.
- The MSPS was administered by psychiatric and nonpsychiatric house staff to 100 consecutive adult patients presenting with suicidal behavior.
- Patient disposition was compared with MSPS scores, and a weighted scoring system was derived based on significant criteria.
Main Results:
- Four specific criteria were identified as highly correlated with the need for hospitalization (P < .001).
- A weighted MSPS, assigning points to specific criteria, demonstrated high sensitivity (94%) and specificity (71%) for identifying patients requiring hospitalization (score ≥ 6).
- A score of ≤ 5 had a 95% negative predictive value for hospitalization, which improved to 100% after excluding patients admitted solely for situational reasons.
Conclusions:
- The weighted MSPS provides a reliable and objective method for nonpsychiatric clinicians to assess suicidality in emergency settings.
- The refined scoring system enhances the accuracy of determining the need for psychiatric hospitalization.
- The tool's validation in a subsequent cohort and lack of mortality in discharged patients support its clinical utility.
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