Citation

Imran JB, Richmond RE, Madni TD, Roaten K, Clark AT, Huang E, Mokdad AA, Taveras LR, AbdelFattah KR, Cripps MW, Eastman AL. J. Trauma Acute Care Surg. 2018; 85(1): 182-186.

Affiliation

The Rees-Jones Trauma Center at Parkland Hospital and the University of Texas Southwestern Department of Surgery, Division of Burn, Trauma, and Critical Care.

Copyright

(Copyright © 2018, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000001899

PMID

29538228

Abstract

BACKGROUND: Trauma patients may be at elevated risk for subsequent suicide; however, it is unclear whether patients at risk can be identified during their initial presentation following injury. The objective of this study was to evaluate the use of a standardized clinical decision support system for suicide risk screening developed by our hospital system and to determine the incidence of positive suicide screenings in our trauma population.

METHODS: Adult trauma patient screenings were performed by nursing staff during the triage process using the Columbia Suicide Severity Rating Scale, Clinical Practice Screener, Recent (C-SSRS). Adult trauma patients who had a suicide risk screening completed from February 2015 to November 2015 were evaluated retrospectively. Patients were divided into cohorts consisting of those with positive and negative screening assessments. Significance was set at α = 0.05. Statistical analysis was performed using Student's t test, and a chi-squared test where appropriate.

RESULTS: Overall, 3623 of 3712 patients (98%) completed a suicide risk screening during the study period. Those who went unscreened were not evaluated due to altered mental status/intubation/emergent surgery (97%), death (1%), or an unwillingness to cooperate (2%). The suicide risk screening was positive in 161 of 3623 patients (4%) in the study cohort. On univariate analysis, patients with a positive suicide risk screen were more likely to be white (43% vs. 32%; p = 0.01), identify English as their primary language (91% vs. 73%; p < 0.01), have insurance coverage (48% vs. 28%; p < 0.01), and were more likely to initiate a low-level trauma activation (27% vs. 16%; p < 0.01) than those who had a negative screening. A positive suicide risk assessment was moderately associated with patients of white race (OR 1.83, 95% CI 1.27- 2.65) on multivariable logistic regression.

CONCLUSION: Our universal suicide screening process identifies an at-risk subpopulation of trauma patients. LEVEL OF EVIDENCE: prognostic, level III.

Language: en