Prediction of Suicide Attempts and Suicide-Related Events Among Adolescents Seen in Emergency Departments.
Prediction of Suicide Attempts and Suicide-Related Events Among Adolescents Seen in Emergency Departments.
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DOI：
10.1001/jamanetworkopen.2022.55986
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发表时间：
2023-02-01
影响因子：
13.8
通讯作者：
King, Cheryl A.
中科院分区：
文献类型：
--
作者：
Brent, David A.;Horowitz, Lisa M.;Grupp-Phelan, Jacqueline;Bridge, Jeffrey A.;Gibbons, Robert;Chernick, Lauren S.;Rea, Margaret;Cwik, Mary F.;Shenoi, Rohit P.;Fein, Joel A.;Mahabee-Gittens, E. Melinda;Patel, Shilpa J.;Mistry, Rakesh D.;Duffy, Susan;Melzer-Lange, Marlene D.;Rogers, Alexander;Cohen, Daniel M.;Keller, Allison;Hickey, Robert W.;Page, Kent;Casper, T. Charles;King, Cheryl A.
询问自杀筛查问题 (ASQ) 和青少年自杀计算机自适应筛查 (CASSY) 工具在预测青少年自杀未遂 (SA) 方面有何不同？在一项对儿科急诊科 2740 名青少年进行为期 3 个月随访的纵向队列研究中，ASQ 和 CASSY 在预测未来 SA 方面表现出很强的预测有效性以及相似的敏感性和特异性。 ASQ 和 CASSY 在有身体症状的患者中表现相似； CASSY 可以更准确地预测那些有精神症状的人的 SA。这项研究表明，对于普遍筛查，两种仪器在有身体症状的患者中都表现良好，但对于一小部分有精神症状的青少年来说，CASSY 具有更高的预测有效性。在急诊科 (ED) 对青少年进行自杀风险筛查是预防自杀的推荐策略。比较筛查措施的预测有效性可以指导急诊临床医生选择筛查工具。比较询问自杀筛查问题 (ASQ) 工具与自杀青少年计算机自适应筛查 (CASSY) 工具，以预测急诊科中不同人口和临床阶层的青少年的自杀行为。针对有自杀风险的青少年的急诊科研究是一项前瞻性、随机系列、多中心队列研究，招募了2017年7月24日至2018年10月29日期间向急诊科就诊的有精神症状的青少年，进行了超采样，并进行了为期3个月的随访，以评估自杀行为的发生情况。该研究包括儿科紧急护理应用研究网络的 14 名儿科急诊室成员和 1 名印度卫生服务急诊室成员。统计分析是在 2021 年 5 月至 2023 年 1 月期间进行的。这项研究使用预测模型来评估结果。主要结局是自杀未遂（SA），次要结局是基线后 3 个月内与自杀相关的急诊室或医院就诊；两者均由不了解基线信息的采访者进行评估。 ASQ 是一份包含 4 项的问卷，调查自杀意念和终生 SA。对任何项目的积极反应或无反应都表明有自杀风险。 CASSY 是一种计算机化的自适应筛选工具，始终包含 3 个 ASQ 项目和平均 8 个附加项目。 CASSY 的连续结果是 SA 的预测概率。在 6513 名青少年中，有 4050 人入组，3965 人完成基线评估，2740 人（1705 名女孩 [62.2%]；入学时平均 [SD] 年龄，15.0 [1.7] 岁；469 名黑人参与者 [17.1%]、678 名西班牙裔参与者 [24.7%] 和 1618 名白人参与者 [59.1%]）完成了两项评估筛查和后续行动。 ASQ 和 CASSY 显示出相似的敏感性（0.951 [95% CI，0.918-0.984] vs 0.945 [95% CI，0.910-0.980]）、特异性（0.588 [95% CI，0.569-0.607] vs 0.643 [95% CI， 0.625-0.662]）、阳性预测值（0.127 [95% CI，0.109-0.146] vs 0.144 [95% CI，0.123-0.165]）和阴性预测值（两者分别为 0.995 [95% CI，0.991-0.998]）。有身体症状的患者的受试者工作特征曲线下面积结果相似（ASQ，0.88 [95% CI，0.81-0.95] vs CASSY，0.94 [95% CI，0.91-0.96]）。在有精神症状的患者中，CASSY 的表现优于 ASQ（分别为 0.72 [95% CI，0.68-0.77] 和 0.57 [95% CI，0.55-0.59]）。这项研究表明 ASQ 和 CASSY 都适合对儿科急诊科患者进行普遍筛查。对于一小部分有精神症状的患者，CASSY 显示出更高的预测有效性。这项队列研究将询问自杀筛查问题工具与计算机化青少年自杀自适应筛查工具进行比较，以预测急诊科 (ED) 中不同人口和临床阶层的青少年的自杀行为。
How do the Ask Suicide-Screening Questions (ASQ) and the Computerized Adaptive Screen for Suicidal Youth (CASSY) instruments compare in predicting suicide attempts (SAs) among adolescents? In a longitudinal cohort study of 2740 youths seen in pediatric emergency departments with a 3-month follow-up, both ASQ and CASSY showed strong predictive validity and similar sensitivity and specificity in predicting future SAs. Both ASQ and CASSY performed similarly among patients with physical symptoms; the CASSY more accurately predicted SAs for those with psychiatric symptoms. This study suggests that for universal screening, both instruments perform well among patients with physical symptoms, but for the small subset of youths with psychiatric symptoms, the CASSY has greater predictive validity. Screening adolescents in emergency departments (EDs) for suicidal risk is a recommended strategy for suicide prevention. Comparing screening measures on predictive validity could guide ED clinicians in choosing a screening tool. To compare the Ask Suicide-Screening Questions (ASQ) instrument with the Computerized Adaptive Screen for Suicidal Youth (CASSY) instrument for the prediction of suicidal behavior among adolescents seen in EDs, across demographic and clinical strata. The Emergency Department Study for Teens at Risk for Suicide is a prospective, random-series, multicenter cohort study that recruited adolescents, oversampled for those with psychiatric symptoms, who presented to the ED from July 24, 2017, through October 29, 2018, with a 3-month follow-up to assess the occurrence of suicidal behavior. The study included 14 pediatric ED members of the Pediatric Emergency Care Applied Research Network and 1 Indian Health Service ED. Statistical analysis was performed from May 2021 through January 2023. This study used a prediction model to assess outcomes. The primary outcome was suicide attempt (SA), and the secondary outcome was suicide-related visits to the ED or hospital within 3 months of baseline; both were assessed by an interviewer blinded to baseline information. The ASQ is a 4-item questionnaire that surveys suicidal ideation and lifetime SAs. A positive response or nonresponse on any item indicates suicidal risk. The CASSY is a computerized adaptive screening tool that always includes 3 ASQ items and a mean of 8 additional items. The CASSY’s continuous outcome is the predicted probability of an SA. Of 6513 adolescents available, 4050 were enrolled, 3965 completed baseline assessments, and 2740 (1705 girls [62.2%]; mean [SD] age at enrollment, 15.0 [1.7] years; 469 Black participants [17.1%], 678 Hispanic participants [24.7%], and 1618 White participants [59.1%]) completed both screenings and follow-ups. The ASQ and the CASSY showed a similar sensitivity (0.951 [95% CI, 0.918-0.984] vs 0.945 [95% CI, 0.910-0.980]), specificity (0.588 [95% CI, 0.569-0.607] vs 0.643 [95% CI, 0.625-0.662]), positive predictive value (0.127 [95% CI, 0.109-0.146] vs 0.144 [95% CI, 0.123-0.165]), and negative predictive value (both 0.995 [95% CI, 0.991-0.998], respectively). Area under the receiver operating characteristic curve findings were similar among patients with physical symptoms (ASQ, 0.88 [95% CI, 0.81-0.95] vs CASSY, 0.94 [95% CI, 0.91-0.96]). Among patients with psychiatric symptoms, the CASSY performed better than the ASQ (0.72 [95% CI, 0.68-0.77] vs 0.57 [95% CI, 0.55-0.59], respectively). This study suggests that both the ASQ and the CASSY are appropriate for universal screening of patients in pediatric EDs. For the small subset of patients with psychiatric symptoms, the CASSY shows greater predictive validity. This cohort study compares the Ask Suicide-Screening Questions instrument with the Computerized Adaptive Screen for Suicidal Youth instrument for the prediction of suicidal behavior among adolescents seen in emergency departments (EDs), across demographic and clinical strata.
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验证在门诊专科和初级保健诊所向年轻人询问自杀筛查问题（ASQ）。
影响因子：
7
作者：
Aguinaldo LD;Sullivant S;Lanzillo EC;Ross A;He JP;Bradley-Ewing A;Bridge JA;Horowitz LM;Wharff EA
通讯作者：
Wharff EA
影响因子：
5.1
作者：
Ahmedani, Brian K.;Westphal, Joslyn;Simon, Gregory E.
通讯作者：
Simon, Gregory E.
影响因子：
4.4
作者：
King, Cheryl A.;O'Mara, Roisin M.;Cunningham, Rebecca M.
通讯作者：
Cunningham, Rebecca M.
影响因子：
3.2
作者：
Andrews, Annie Lintzenich;Bettenhausen, Jessica;Auger, Katherine A.
通讯作者：
Auger, Katherine A.
影响因子：
3.1
作者：
Horowitz LM;Bridge JA;Tipton MV;Abernathy T;Mournet AM;Snyder DJ;Lanzillo EC;Powell D;Schoenbaum M;Brahmbhatt K;Pao M
通讯作者：
Pao M