OBJECTIVES: The goal of this study was to evaluate the relationship between 
various suicide screening tools and clinical impression with subsequent patient 
psychiatric admission and near-term adverse emergency department (ED) events.
METHODS: We performed a prospective observational study of 50 patients with 
suicidal ideation in the ED. Subjects completed a series of depression/suicide 
screening tools: the Columbia Suicide Severity Scale, SAD PERSONS scale, Patient 
Health Questionnaire 9, and Beck Scale for Suicidal Ideation. Clinicians were 
also asked about their impression on likelihood of patient admission. Outcome 
measures were as follows: need for psychiatric hospital admission, prolonged 
stay at psychiatric facility, and any adverse events during ED stay including 
need for unscheduled psychiatric or sedating medications, need for physical 
restraints, and need for intervention by security staff.
RESULTS: The Beck Scale for Suicidal Ideation, Patient Health Questionnaire 9, 
and Columbia Suicide Severity Scale did not significantly predict within-ED 
adverse events or admissions to psychiatric facilities. Wald test for individual 
parameters at an α of .10 level found that patients who were screened positive 
by their nurse had 3.37 times the odds of adverse within-ED events; patients 
with a positive SAD PERSONS score had 8.18 times the odds of psychiatric 
admission greater than 5 days. However, at the α of .05 level, no screening 
tools correlated with patient ED course or likelihood of psychiatric admission.
CONCLUSION: Clinical impression alone and the suicide screening tools showed 
poor predictive value for near-term events. Data from this study highlight the 
need for the development of ED-based suicide screening instruments capable of 
identifying those patients with suicidal ideation at greatest risk.