Lisa M Horowitz, Jeffrey A Bridge, Stephen J Teach, Elizabeth Ballard, Jennifer Klima, Donald L Rosenstein, Elizabeth A Wharff, Katherine Ginnis, Elizabeth Cannon, Paramjit Joshi, Maryland Pao
{"title":"询问自杀筛查问题（ASQ）：儿科急诊科的一个简短工具。","authors":"Lisa M Horowitz, Jeffrey A Bridge, Stephen J Teach, Elizabeth Ballard, Jennifer Klima, Donald L Rosenstein, Elizabeth A Wharff, Katherine Ginnis, Elizabeth Cannon, Paramjit Joshi, Maryland Pao","doi":"10.1001/archpediatrics.2012.1276","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To develop a brief screening instrument to assess the risk for suicide in pediatric emergency department patients.</p><p><strong>Design: </strong>A prospective, cross-sectional instrument-development study evaluated 17 candidate screening questions assessing suicide risk in young patients. The Suicidal Ideation Questionnaire served as the criterion standard.</p><p><strong>Setting: </strong>Three urban, pediatric emergency departments associated with tertiary care teaching hospitals.</p><p><strong>Participants: </strong>A convenience sample of 524 patients aged 10 to 21 years who presented with either medical/surgical or psychiatric chief concerns to the emergency department between September 10, 2008, and January 5, 2011.</p><p><strong>Main exposures: </strong>Participants answered 17 candidate questions followed by the Suicidal Ideation Questionnaire.</p><p><strong>Main outcome measures: </strong>Sensitivity, specificity, predictive values, likelihood ratios, and area under the receiver operating characteristic curves of the best-fitting combinations of screening questions for detecting elevated risk for suicide.</p><p><strong>Results: </strong>A total of 524 patients were screened (344 medical/surgical and 180 psychiatric). Fourteen of the medical/surgical patients (4%) and 84 of the psychiatric patients (47%) were at elevated suicide risk on the Suicidal Ideation Questionnaire. Of the 17 candidate questions, the best-fitting model comprised 4 questions assessing current thoughts of being better off dead, current wish to die, current suicidal ideation, and past suicide attempt. This model had a sensitivity of 96.9% (95% CI, 91.3-99.4), specificity of 87.6% (95% CI, 84.0-90.5), and negative predictive values of 99.7% (95% CI, 98.2-99.9) for medical/surgical patients and 96.9% (95% CI, 89.3-99.6) for psychiatric patients.</p><p><strong>Conclusions: </strong>A 4-question screening instrument, the Ask Suicide-Screening Questions (ASQ), with high sensitivity and negative predictive value, can identify the risk for suicide in patients presenting to pediatric emergency departments.</p>","PeriodicalId":8310,"journal":{"name":"Archives of pediatrics & adolescent medicine","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2012-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/archpediatrics.2012.1276","citationCount":"318","resultStr":"{\"title\":\"Ask Suicide-Screening Questions (ASQ): a brief instrument for the pediatric emergency department.\",\"authors\":\"Lisa M Horowitz, Jeffrey A Bridge, Stephen J Teach, Elizabeth Ballard, Jennifer Klima, Donald L Rosenstein, Elizabeth A Wharff, Katherine Ginnis, Elizabeth Cannon, Paramjit Joshi, Maryland Pao\",\"doi\":\"10.1001/archpediatrics.2012.1276\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To develop a brief screening instrument to assess the risk for suicide in pediatric emergency department patients.</p><p><strong>Design: </strong>A prospective, cross-sectional instrument-development study evaluated 17 candidate screening questions assessing suicide risk in young patients. The Suicidal Ideation Questionnaire served as the criterion standard.</p><p><strong>Setting: </strong>Three urban, pediatric emergency departments associated with tertiary care teaching hospitals.</p><p><strong>Participants: </strong>A convenience sample of 524 patients aged 10 to 21 years who presented with either medical/surgical or psychiatric chief concerns to the emergency department between September 10, 2008, and January 5, 2011.</p><p><strong>Main exposures: </strong>Participants answered 17 candidate questions followed by the Suicidal Ideation Questionnaire.</p><p><strong>Main outcome measures: </strong>Sensitivity, specificity, predictive values, likelihood ratios, and area under the receiver operating characteristic curves of the best-fitting combinations of screening questions for detecting elevated risk for suicide.</p><p><strong>Results: </strong>A total of 524 patients were screened (344 medical/surgical and 180 psychiatric). Fourteen of the medical/surgical patients (4%) and 84 of the psychiatric patients (47%) were at elevated suicide risk on the Suicidal Ideation Questionnaire. Of the 17 candidate questions, the best-fitting model comprised 4 questions assessing current thoughts of being better off dead, current wish to die, current suicidal ideation, and past suicide attempt. This model had a sensitivity of 96.9% (95% CI, 91.3-99.4), specificity of 87.6% (95% CI, 84.0-90.5), and negative predictive values of 99.7% (95% CI, 98.2-99.9) for medical/surgical patients and 96.9% (95% CI, 89.3-99.6) for psychiatric patients.</p><p><strong>Conclusions: </strong>A 4-question screening instrument, the Ask Suicide-Screening Questions (ASQ), with high sensitivity and negative predictive value, can identify the risk for suicide in patients presenting to pediatric emergency departments.</p>\",\"PeriodicalId\":8310,\"journal\":{\"name\":\"Archives of pediatrics & adolescent medicine\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2012-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1001/archpediatrics.2012.1276\",\"citationCount\":\"318\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Archives of pediatrics & adolescent medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1001/archpediatrics.2012.1276\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of pediatrics & adolescent medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1001/archpediatrics.2012.1276","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Ask Suicide-Screening Questions (ASQ): a brief instrument for the pediatric emergency department.
Objective: To develop a brief screening instrument to assess the risk for suicide in pediatric emergency department patients.
Design: A prospective, cross-sectional instrument-development study evaluated 17 candidate screening questions assessing suicide risk in young patients. The Suicidal Ideation Questionnaire served as the criterion standard.
Setting: Three urban, pediatric emergency departments associated with tertiary care teaching hospitals.
Participants: A convenience sample of 524 patients aged 10 to 21 years who presented with either medical/surgical or psychiatric chief concerns to the emergency department between September 10, 2008, and January 5, 2011.
Main exposures: Participants answered 17 candidate questions followed by the Suicidal Ideation Questionnaire.
Main outcome measures: Sensitivity, specificity, predictive values, likelihood ratios, and area under the receiver operating characteristic curves of the best-fitting combinations of screening questions for detecting elevated risk for suicide.
Results: A total of 524 patients were screened (344 medical/surgical and 180 psychiatric). Fourteen of the medical/surgical patients (4%) and 84 of the psychiatric patients (47%) were at elevated suicide risk on the Suicidal Ideation Questionnaire. Of the 17 candidate questions, the best-fitting model comprised 4 questions assessing current thoughts of being better off dead, current wish to die, current suicidal ideation, and past suicide attempt. This model had a sensitivity of 96.9% (95% CI, 91.3-99.4), specificity of 87.6% (95% CI, 84.0-90.5), and negative predictive values of 99.7% (95% CI, 98.2-99.9) for medical/surgical patients and 96.9% (95% CI, 89.3-99.6) for psychiatric patients.
Conclusions: A 4-question screening instrument, the Ask Suicide-Screening Questions (ASQ), with high sensitivity and negative predictive value, can identify the risk for suicide in patients presenting to pediatric emergency departments.
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