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Determining suicide risk in trauma patients using a universal screening program

Imran, Jonathan B., MD; Richmond, Robyn E., MD; Madni, Tarik D., MD; Roaten, Kimberly, PhD; Clark, Audra T., MD; Huang, Emily Y.; Mokdad, Ali A., MD; Taveras, Luis R., MD; Abdelfattah, Kareem R., MD; Cripps, Michael W., MD, MSCS; Eastman, Alexander L., MD, MPH

Journal of Trauma and Acute Care Surgery: July 2018 - Volume 85 - Issue 1 - p 182–186
doi: 10.1097/TA.0000000000001899
EAST Quickshot Presentations

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 objectives of this study were 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 t test and a χ2 test where appropriate.

RESULTS Overall, 3,623 of 3,712 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 result was positive in 161 of 3,623 patients (4%) in the study cohort. On univariate analysis, patients with a positive suicide risk screen result 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 result. A positive suicide risk assessment result was moderately associated with patients of white race (odds ratio, 1.83; 95% confidence interval, 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 study, level III; therapeutic, level IV.

From the Department of Surgery, The University of Texas Southwestern, Dallas, TX, (J.B.I., R.E.R., T.D.M., A.T.C., E.H., A.A.M., L.R.T., K.R.A., M.W.C., A.L.E.); The Rees-Jones Trauma Center at Parkland Hospital; and Department of Surgery, Division of Burn, Trauma, and Critical Care, The University of Texas Southwestern, Dallas, TX (K.R.A., M.W.C., A.L.E.); Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX (K.R.); and Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX (R.E.R.).

Submitted: November 30, 2017, Revised: January 4, 2018, Accepted: February 27, 2018, Published online: March 14, 2018.

This original work was presented as a quick shot presentation at the 31st Eastern Association for the Surgery of Trauma, January 9–13, 2018 in Lake Buena Vista, Florida, and has not been submitted or published elsewhere.

Address for reprints: Alexander L. Eastman, MD, University of Texas Southwestern Medical Center, Department of Surgery, Division of Burn, Trauma, and Critical Care, 5323 Harry Hines Blvd, E5.508, Dallas, Texas; email:

© 2018 Lippincott Williams & Wilkins, Inc.