SCOTTSDALE, ARIZ. – Emergency department physicians need to do a better job assessing psychiatric patients for possible violent behavior, Marisa A. Giggie, M.D., of the department of psychiatry at the University of Texas, San Antonio, and her colleagues said in a poster presentation at the annual meeting of the American Academy of Psychiatry and the Law.
They performed a case-control chart review of 425 patients aged under 18 years who were evaluated in the university's psychiatric emergency department between June 1, 2001, and Dec. 31, 2002.
Among the patients studied, 57% were female and the average age was 14. The majority of patients–63%–were Hispanic, while 28% were white and 9% were black.
The patients' chief complaints were grouped into three categories: violence, suicide, or other. Of the 84 patients whose chief complaint was violence, only 63% were asked if they had a history of violent behavior, Dr. Giggie and her associates noted. Of those who were asked, 92% said that they did have such a history.
The pattern was similar for other questions. Only 29% of the violence patients were asked about previous police contact, but of those, 85% answered affirmatively. Of the patients whose chief complaint was suicide, only 7% were asked about a history of domestic violence, but all of those asked had a history of it.
“Residency training needs to focus on better preparing residents to do thorough risk assessment for violent youth,” the investigators concluded. “Assessing children and adolescents for violence in this setting is important because they often present with severe behavioral problems, suicidal ideation, and violent threats. Increased training in risk assessment for pediatric patients should occur before residents rotate through psychiatric emergency rooms.”
Joyce Frieden