Ask Suicide-Screening Questions (ASQ) A Brief Instrument for the Pediatric Emergency Department
Ask Suicide-Screening Questions (ASQ) A Brief Instrument for the Pediatric Emergency Department
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DOI：
10.1001/archpediatrics.2012.1276
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发表时间：
2012-12-01
影响因子：
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通讯作者：
Pao, Maryland
中科院分区：
文献类型：
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作者：
Horowitz, Lisa M.;Bridge, Jeffrey A.;Pao, Maryland
目的：建立一种评估儿科急诊科患者自杀风险的简易筛查工具。设计：一项前瞻性、横断面工具开发研究评估了17个评估年轻患者自杀风险的候选筛选问题。自杀意念问卷作为判定标准。环境：与三级护理教学医院相关的三个城市儿科急诊科。参与者：在2008年9月10日至2011年1月5日期间就诊于急诊科的524例年龄在10 - 21岁的内科/外科或精神科患者作为方便样本。主要暴露：参与者回答了17个候选问题，然后进行了自杀意念问卷。主要结果测量：敏感度、特异度、预测值、似然比，以及检测自杀风险升高的筛选问题的最佳拟合组合的接受者工作特征曲线下的面积。结果：共筛选了524例患者（内科/外科344例，精神科180例）。在自杀意念问卷调查中，14名内科/外科病人（4%）和84名精神病病人（47%）的自杀风险较高。在17个候选问题中，最合适的模型包括4个问题，评估当前对死了会更好的想法、当前的死亡愿望、当前的自杀意念和过去的自杀企图。该模型的敏感性为96.9% (95% CI, 91.3-99.4)，特异性为87.6% (95% CI, 84.0-90.5)，内科/外科患者的阴性预测值为99.7% (95% CI, 98.2-99.9)，精神病患者的阴性预测值为96.9% （95% CI, 89.3-99.6）。结论：ASQ （Ask suicide - screening Questions）是一种4题筛查工具，具有高灵敏度和阴性预测值，可以识别儿科急诊科就诊患者的自杀风险。
Objective: To develop a brief screening instrument to assess the risk for suicide in pediatric emergency department patients.Design: A prospective, cross-sectional instrument-development study evaluated 17 candidate screening questions assessing suicide risk in young patients. The Suicidal Ideation Questionnaire served as the criterion standard.Setting: Three urban, pediatric emergency departments associated with tertiary care teaching hospitals.Participants: A convenience sample of 524 patients aged 10 to 21 years who presented with either medical/surgical or psychiatric chief concerns to the emergency department between September 10, 2008, and January 5, 2011.Main Exposures: Participants answered 17 candidate questions followed by the Suicidal Ideation Questionnaire.Main Outcome Measures: Sensitivity, specificity, predictive values, likelihood ratios, and area under the receiver operating characteristic curves of the best-fitting combinations of screening questions for detecting elevated risk for suicide.Results: A total of 524 patients were screened (344 medical/surgical and 180 psychiatric). Fourteen of the medical/surgical patients (4%) and 84 of the psychiatric patients (47%) were at elevated suicide risk on the Suicidal Ideation Questionnaire. Of the 17 candidate questions, the best-fitting model comprised 4 questions assessing current thoughts of being better off dead, current wish to die, current suicidal ideation, and past suicide attempt. This model had a sensitivity of 96.9% (95% CI, 91.3-99.4), specificity of 87.6% (95% CI, 84.0-90.5), and negative predictive values of 99.7% (95% CI, 98.2-99.9) for medical/surgical patients and 96.9% (95% CI, 89.3-99.6) for psychiatric patients.Conclusions: A 4-question screening instrument, the Ask Suicide-Screening Questions (ASQ), with high sensitivity and negative predictive value, can identify the risk for suicide in patients presenting to pediatric emergency departments.