Craig Spencer's Data Collection Project Fuels Innovation

Craig Spencer's Data Collection Project Fuels Innovation

EPI Journal

Rwandan fellowship project gives insight into the value for reliable data and the need for experienced local partners

In Memoriam: Gail Anderson

In Memoriam: Gail Anderson

1925 – 2014

Founding Father of Emergency Medicine

Market Forces

Market Forces

The Recruiter

Today’s EM job market: Know your target regions, tailor your goals and set yourself up for success

Doctors Say the Craziest Things

Doctors Say the Craziest Things

Financial Consult

Emergency physicians say some strange things when they're explaining their investment strategies. Here are four phrases to avoid

Go Big (Data) or Go Home

Go Big (Data) or Go Home

ED Benchmarking

Variations in practice make granular benchmarking comparisons troublesome. Fortunately, the EDBA’s big data has your back

Consider Tranexamic Acid for Traumatic Hemorrhage

Consider Tranexamic Acid for Traumatic Hemorrhage

Journal Club

Why the early use of TXA should be strongly considered for any patient requiring blood products for trauma-related hemorrhage

Greg Henry's ACEP Odyssey

Greg Henry's ACEP Odyssey

Welcome to the City of the Big Shoulders

The Unauthorized Guide to the ACEP Scientifc Assembly

Keeping an Eye on 72-Hour Bouncebacks

Keeping an Eye on 72-Hour Bouncebacks

Director's Corner

Dear Director, My CEO is concerned about our ED’s quality because we’ve experienced a recent increase in our 72-hour returns…

Flips, Falls and Other Orthopedic Adventures

Flips, Falls and Other Orthopedic Adventures

Practical Pediatrics

How to narrow down the diagnosis of pediatric leg pain when all categories of hip pain remain on the differential

Open Injuries to Flexor Compartment of Fingers and Hands

Open Injuries to Flexor Compartment of Fingers and Hands

Core Knowledge

Visualize, visualize, visualize. The decision to resort to surgery is multifaceted, based on location of injury, amount of damage and…

'Hey Doc, I Just Can't Pee'

'Hey Doc, I Just Can't Pee'

Ultrasound

You’ve got a seemingly straightforward complaint. Should you reach for your Foley or your ultrasound probe?

So EHRs Don’t Hurt Patient Sat or Throughput. Next?

So EHRs Don’t Hurt Patient Sat or Throughput. Next?

Measuring EHR Effectiveness

EHR usability needs to improve, but we need to focus on patient safety issues 

EHRs Are Inevitable, Yet Studies Still Pose Serious Questions

EHRs Are Inevitable, Yet Studies Still Pose Serious Questions

Measuring EHR Effectiveness

We’re seeing a dramatic increase in testing and a shocking amount of physician time being spent on electronic medical records

DEA Shifts Hydrocodone to Schedule II

DEA Shifts Hydrocodone to Schedule II

Fed’s Clamp Down on Hydrocodone

A good pill is hard to find - The reclassification of hydrocodone may make some EPs reluctant to prescribe it

When Ebola Shows Up At Your ED

When Ebola Shows Up At Your ED

Facts and Risk Levels

"Hey Dr T! We’ve got an Ebola suspect in room 64 for you. Don’t worry, we’ll walk you through this."

Frontpage Slideshow | Copyright © 2006-2014 JoomlaWorks Ltd.
Print
E-mail
Reprint
Review by Ryan Petersen, M.D.
Column organized by Evan Schwarz, M.D.
Washington University in St. Louis
Division of Emergency Medicine
 
Doshi, A, Boudreaux, ED, Wang N, et al.  National Study of US emergency department visits for attempted suicide and self-inflicted injury, 1997-2001.  Ann Emerg Med.  Oct 2005; 46 (4):  369-375.
 
While working an evening shift in the emergency department you encounter an 18-year-old female who has attempted suicide by Tylenol ingestion.  Her exam is unremarkable, but her past history is significant for depression and alcohol abuse.  As you order labs, you wonder what type of patient typically presents with a suicide attempt, what means do they use, and if they are at a greater risk to complete suicide.

Suicide is the eighth leading cause of death within the United States, and is responsible for approximately 30,000 deaths annually. It accounts for more than 400,000 ED visits per year. The majority of epidemiologic studies have focused on completed suicide rather than on suicide attempt or intentional self-injury.  The attempted to completed suicide ratio is 8:1, thus many of these studies fail to define the typical case that presents to an emergency department.  This article employs data from the National Hospital Ambulatory Medical Care Survey to further define this population of patients.
Visits for attempted suicide and self-inflicted injury accounted for 0.4% of the total ED visits between 1997 and 2001.  ED visits varied according to age, sex, and race.  The mean patient age was 31 years old and visits were most common among 15 to 19 year olds.
 

Age

 

Rate (per 1,000 ED visits)

 

15-19 years old

 

3.3

 

20-29 years old

 

2.9

 

30-49 years old

 

2.0

 

Sex

 

 

 

 

Males

 

1.3

 

Females

 

1.7

 

Race

 

 

 

 

White

 

1.5

 

African American

 

1.9

 

 
However other studies concluded that whites have a higher rate of suicide attempts than African Americans.  The most common method of attempted suicide was poisoning (68%), cutting/piercing instruments (20%), hanging (<1%) and firearms (<1%).

Suicide attempts were associated with psychiatric disorders and alcohol abuse.  Psychiatric disorders were coded in 55% of those presenting with a suicide attempt, with depressive disorder being present in 18%. Alcohol abuse was present in 9%.  Between 40-60% of people who commit suicide are intoxicated at death.  With psychiatric conditions and intoxication being so prevalent in this population, it is very important to document mental status exam and suspicion of intoxication if an alcohol level is not ordered.  Only 43% of charts included a mental status exam and only 25% had an ethanol level.  Suicide is the third leading cause of death among 15 to 24 years olds.  This may be due to factors such as self-doubt, pressure to succeed, and role confusion.  Either way the ED may be their first point of contact with health care in order to get help. 
The populations of patients who present with suicide attempt vary greatly when compared to those who have completed suicide.  Patients who complete suicide are typically older, men, living alone, physically ill, and utilize a more lethal means of suicide.  In contrast, those who attempt suicide are younger, women with psychosocial risk factors such as depression, substance abuse, and other mental disorders.  It should be kept in mind that these patients can still have significant injuries as one third are admitted with one third of those being admitted to the ICU.  Evidence suggests that those who present with a suicide attempt have a significant risk of eventually completing suicide.  As emergency department physicians, we have a unique task of identifying these patients.  This is made more challenging as attempted suicide trended to be more common at night than the trend for overall ED visits when many of the resources these patients need may not be available.  Scales such as the SAD PERSONS and Manchester Self-Harm Rule are available to help risk stratify patients.  Proper assessment and clinical management may help prevent suicide and future suicide attempts.
 
 

Add comment

Security code
Refresh

Popular Authors

  • Greg Henry
  • Rick Bukata
  • Mark Plaster
  • Kevin Klauer
  • Jesse Pines
  • David Newman
  • Rich Levitan
  • Ghazala Sharieff
  • Nicholas Genes
  • Jeannette Wolfe
  • William Sullivan
  • Michael Silverman

Subscribe to EPM