Hood Alex P, Tibbits Lauren M, Laporta Juan I, Carrillo Jennifer, Adams Lacee R, Young-McCaughan Stacey, Peterson Alan L, De Lorenzo Robert A
University of Texas Health Science Center at San Antonio, Department of Emergency Medicine, San Antonio, Texas.
Baylor University, Department of Psychology and Neuroscience, Waco, Texas.
West J Emerg Med. 2024 Nov;25(6):858-868. doi: 10.5811/westjem.18640.
Suicidality is a growing problem in the US, and the emergency department (ED) is often the front line for the management and effective treatment of acutely suicidal patients. There is a dearth of interventions that emergency physicians may use to manage and effectively treat acutely suicidal patients. To the extent that recently described interventions are available for ED personnel, no review has been conducted to identify them. This scoping review is intended to fill this gap by systematically reviewing the literature to identify recently described interventions that can be administered in the ED to reduce symptoms and stabilize patients.
We conducted a search of PubMed, SCOPUS, and CINAHL in January 2024 to identify papers published between 2013-2023 for original research trialing recent interventions for the effective treatment of suicidality in the ED. We assessed 16 full-text articles for eligibility, and nine met inclusion criteria. Included studies were evaluated for features and characteristics, the fit of the intervention to the ED environment, and interventional efficacy.
Four studies assessed the efficacy of a single dose of the anesthetic/analgesic agent ketamine. Three studies assessed the efficacy of a brief psychosocial intervention delivered in the ED, two of which paired this intervention with the provision of follow-up care (postcard contact and referral assistance/case management, respectively). The remaining two studies trialed a brief, motivational interviewing-based intervention. Included studies had strong experimental designs (randomized controlled trials) but small sample sizes (average 57). Among the interventions represented across these nine studies, a single dose of ketamine and the brief psychosocial intervention Crisis Response Planning (CRP) show promise as ED-appropriate interventions for suicidality. Ketamine and CRP demonstrated the strongest fit to the ED environment and most robust efficacy findings.
This review identified one drug (ketamine) and four unique psychological/behavioral interventions that have been used to treat acute suicidality in the ED. There is currently insufficient evidence to suggest that these interventions will prove efficacious and well-suited to be delivered in the ED environment. Future studies should continue to test these interventions in the ED setting to determine their feasibility and efficacy.
自杀问题在美国日益严重，急诊科（ED）往往是急性自杀患者管理和有效治疗的第一线。急诊医生可用于管理和有效治疗急性自杀患者的干预措施匮乏。就近期描述的可供急诊人员使用的干预措施而言，尚未进行综述以识别它们。本范围综述旨在通过系统回顾文献来填补这一空白，以识别近期描述的可在急诊科实施以减轻症状并使患者稳定的干预措施。
我们于2024年1月在PubMed、SCOPUS和CINAHL数据库进行检索，以识别2013年至2023年期间发表的关于在急诊科对自杀行为进行有效治疗的近期干预措施的原始研究论文。我们评估了16篇全文文章的 eligibility，其中9篇符合纳入标准。对纳入研究的特征、干预措施与急诊科环境的契合度以及干预效果进行了评估。
四项研究评估了单剂量麻醉/镇痛剂氯胺酮的疗效。三项研究评估了在急诊科实施的简短心理社会干预的疗效，其中两项将该干预与后续护理（分别为明信片联系和转诊协助/病例管理）相结合。其余两项研究试验了一种简短的、基于动机访谈的干预措施。纳入研究具有强大的实验设计（随机对照试验），但样本量较小（平均57例）。在这九项研究涵盖的干预措施中，单剂量氯胺酮和简短心理社会干预危机应对计划（CRP）显示出作为急诊科适用的自杀行为干预措施的前景。氯胺酮和CRP与急诊科环境的契合度最强，疗效结果也最为显著。
本综述确定了一种药物（氯胺酮）和四种独特的心理/行为干预措施，这些措施已被用于治疗急诊科的急性自杀行为。目前尚无足够证据表明这些干预措施将被证明有效且适合在急诊科环境中实施。未来的研究应继续在急诊科环境中测试这些干预措施，以确定其可行性和疗效。
