What's Your Diagnosis? Suicidal Ideation and Self-Harm in Children

Welcome to this month’s What’s Your Diagnosis Challenge!

But before we begin, check to see if you got the previous case on Febrile Infants Aged ≤60 Days: Evaluation and Management in the Emergency Department right.

Case Presentation: Evaluation and Management of Suicidal Ideation and Self-Harm in Children in the Emergency Department

A 13-year-old girl presents with her father with the request for a medical evaluation after she ran away from home for 24 hours…

The girl tells you she wanted to hang out with friends after recently getting into an argument with her father about her grades at school. She has a history of depression noted in the electronic medical record and no prior ED visits.
During triage assessment, the patient avoids eye contact with the triage nurse and answers questions with few words.
You wonder whether there is more to this patient’s story and what questions you should ask when interviewing the patient in a room.

Case Conclusion

The triage nurse used the ASQ screening tool while performing intake for the girl, and identified that the girl had thoughts of killing herself in the past week. You placed the girl in a safe room and conducted a confidential interview with her. She shared that she had suicidal thoughts in the past week with a plan to hang herself. She also reported childhood trauma and prior physical abuse by her father. You conducted a brief suicide safety assessment and concluded that the patient was at high risk and required assessment by a mental health provider. You also filed a mandated report and contacted Child Protective Services due to her disclosure of prior abuse. Telehealth was utilized for the mental health assessment, and the patient was transferred to an inpatient psychiatric unit for further care.