Care or Crisis? Exploring Variations in Emergency Department Management of Pediatric Suicide Risk

Acute care settings often serve as the first point of contact for pediatric patients at risk of suicide, requiring clinicians to make complex decisions about care. There is significant variability in suicide risk management across pediatric emergency departments (EDs) in the United States. In this work, we examined the care provided to pediatric patients with suicide risk in the ED setting and whether this care varies by key demographic factors, such as age, race, sex, or income status.

In this retrospective analysis of electronic health record (EHR) data from 2 pediatric ED settings, we used a series of mixed multilevel regression models to evaluate differences in ED length of stay, admission, and the odds of ordered home psychotherapeutic medications or intramuscular restraint medications in patients with identified suicide risk.

Among visits with identified suicide risk, patients with private insurance were more likely to have home psychotherapeutic medication ordered (aOR: 1.74, 95% CI: 1.25-2.43). Compared with White patients, Black patients had a 23% shorter LOS (aIRR: 0.77, 95% CI: 0.65-0.91), were 65% less likely to receive ED-ordered home psychotherapeutic medication (aOR: 0.35, 95% CI: 0.25-0.49), and were 48% less likely to be admitted (aOR: 0.52, 95% CI: 0.35-0.76). Hispanic/Latino patients had 72% lower odds of receiving ED-ordered home psychotherapeutic medication (aOR: 0.28, 95% CI: 0.16-0.49).

There is substantial variation in the emergency care of youth presenting with suicide risk. Our findings demonstrate significant differences in LOS, discharge disposition, and ED-medication management across insurance types and racial and ethnic groups.