%0 Journal Article
%T Impact of the Abbreviated Suicide Crisis Syndrome Checklist on clinical decision making in the emergency department
%J Journal of clinical psychiatry
%D 2023
%A Karsen, Ethan
%A Cohen, Lisa J.
%A White, Betsy
%A De, Gabriele P.
%A Goncearencoa, Inna
%A Galynker, Igor I.
%A Miller, Frederick E.
%V 84
%N 3
%P 22m14655-22m14655
%X 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>
%G en
%I Physicians Postgraduate Press
%@ 0160-6689
%U http://dx.doi.org/10.4088/JCP.22m14655