@article{ref1,
title="Impact of the Abbreviated Suicide Crisis Syndrome Checklist on clinical decision making in the emergency department",
journal="Journal of clinical psychiatry",
year="2023",
author="Karsen, Ethan and Cohen, Lisa J. and White, Betsy and De, Gabriele P. and Goncearencoa, Inna and Galynker, Igor I. and Miller, Frederick E.",
volume="84",
number="3",
pages="22m14655-22m14655",
abstract="OBJECTIVE: The suicide crisis syndrome (SCS), an acute negative affect state predictive of near-term suicidal behavior, is currently under review for inclusion as a suicide-specific diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM). While the predictive validity of the SCS for near-term suicidal behavior is well documented, its real-world clinical utility has yet to be evaluated. As such, this study evaluated how implementation of a novel assessment tool, the Abbreviated SCS Checklist (A-SCS-C), into the electronic medical records (EMRs) influenced disposition decisions in the emergency departments (EDs) of a large urban health system. <br><br>METHODS: Logistic regression analyses evaluated the impact of SCS diagnosis on 212 admission/discharge decisions after accounting for chief complaints of suicidal ideation (SI), suicidal behavior (SB), and psychosis/agitation. <br><br>RESULTS: The A-SCS-C was concordant with 86.9% of all non-psychotic disposition decisions. In multivariable analysis, the A-SCS-C had an adjusted odds ratio (AOR) of 65.9 (95% confidence interval: 18.79-231.07) for inpatient admission, whereas neither suicidal ideation nor behavior was a significant predictor. The effect size remained very high in 3 sensitivity analyses, the first using information from a different section of the EMR, the second in patients younger than 18 years, and the third in males and females separately (AORs > 30). <br><br>CONCLUSIONS: SCS diagnosis, when implemented in ED EMRs alongside SI and SB, was strongly predictive of clinician decision making with regard to admission/discharge, particularly in non-psychotic patients, while SI and SB were noncontributory. Overall, our results show that the SCS, as a diagnostic entity, demonstrates robust clinical utility and may reduce the limitations of relying on self-reported SI as a primary basis of suicide risk assessment.<p /> <p>Language: en</p>",
language="en",
issn="0160-6689",
doi="10.4088/JCP.22m14655",
url="http://dx.doi.org/10.4088/JCP.22m14655"
}