Suicide Patients Presenting in the ED:

1
Suicide Patients Presenting in the ED How many
times can you be triaged for suicide ideation?
H. Soe-Lin, MS1 T. Orr2 L. Baldassari MS1
D.P. Milzman, MD FACEP2
1Georgetown University School of Medicine,
Washington D.C. Georgetown/Washington Hospital
Center EM Residency Program, Washington D.C.2
Georgetown University
Discussion
Methods
Results (cont.)
Abstract

• Setting urban hospital, 950 patient beds, ED
  with 80,000 annual visits
• Retrospective data collection using Azyxxi data
  record developed by Smith and Feeid (Microsoft,
  Redmond WA)
• Patients included presented with triage complaint
  or ED diagnosis of suicide or spelling variants
  between 2002-2007.
• Cohort of 3742 patient records (SI Cohort)
  screened against Social Security Death Registry
  (http//ssdi.rootsweb.com/cgi-bin/ssdi.cgi) to
  obtain mortality statistics.
• Subcohort of 108 patients with a positive match
  for death on the SSNDR (Death Cohort) was
  identified and siociodemographics and
  co-morbidities were characterized.
• True suicides as primary cause of death were then
  ruled in by cross-referencing of this subcohort
  with the District of Columbias Medical Examiners
  Office

Patients presenting to the ED with suicide
ideation represent a demographically distinct
subset of the ED population. Although treated
very seriously, suicide ideators have a
relatively low mortality rate following
discharge. In the current study the death
cohort had a mean time of 5.5 years between first
visit to the ED and death, and 3.4 years between
first presentation of SI in the ED and death.
Co-morbidities in this population were
significant, with EtOH/substance abuse, HIV, and
mental illnesses topping the list. Age was a
significant predictor of death within those
presenting with SI, as was race though not when
corrected for age. Gender status was not an
independent predictor of death. Further
cross-referencing with the D.C. medical examiners
office yielded 12 / 109 records with confirmed
suicide as the primary cause of death, yielding
an overall death rate from suicide of this cohort
at only 0.5. Because patients presenting with
SI have a higher number of ED visits than the
general ED population (13.4-17.1 vs. 4.3), and
therefore represent an increased burden on ED
resources, the relatively low mortality rate of
this cohort of patients suggests a need to
re-evaluate risk stratification for patients
presenting with this condition.
Psychiatric patients exhibit increased suicide
risk shortly after hospitalization, but little is
known about the fate of patients who are
discharged after treatment. In the U.S. there is
a lack of supporting documentation for outcomes
following ED admits for suicidal ideation. This
study reports mortality data and
sociodemographics of a cohort from a multi-year
follow up on all patients with suicidal ideations
admitted to a major urban emergency department
over a period of 6 yrs.
Background

• Suicide is the 11th leading cause of death in the
  US accounting for 32,439 deaths in 2004
• Overall death rate is 10.9/100,000 with between 8
  and 25 attempts per completed suicide
• Firearms represent the primary mechanism in
  greater than 50 of completed suicides
• Risk factors
• Age gt65yrs have an increased death rate of
  14.3/100,000
• Ethnicity
• Native Americans/Non-Hispanic Whites
  12.4-12.9/100,000
• Asians/Black/Hispanic5.3-5.9/100,000

Results
For additional information Please contact Dave
Milzman, MD FACEP Emergency Department Washington
Hospital Center davidmilzman_at_comcast.net