Can we predict agitation in patients with suicide attempts in the emergency department?

Ayhan Akoz, Sultan Tuna Akgol Gur, Elif Oral, Ummu Zeynep Avsar, Mucahit Emet
1. Adnan Menderes University Medicine Faculty Department of Emergency Medicine, Aydin, Turkey
2. Ataturk University Medicine Faculty Department of Emergency Medicine, Erzurum, Turkey
3. Ataturk University Medicine Faculty Department of Psychiatry, Erzurum, Turkey
4. Ataturk University Medicine Faculty Department of Medical Education, Erzurum, Turkey

Abstract
Background: The agitation in patients presenting to the emergency department (ED) after suicide attempts is common and an  important problem.

Objective:To establish whether we can predict agitated patients among suicide attempt patients in ED.

Methods: This is a cross-sectional observational study of adult suicide attempt events in ED. Information was collected prospectively on a specially designed data-collection form. Patients aged 16 years old and above who presented to the ED for care  due to suicide attempts were included in the study. Suicide attempts were grouped as aggressive and non-aggressive attempts.

Results:A total of 533 patients were included. Forty-three of these patients had agitation in ED (8%). Non-aggressive suicide  attempts were referred to psychiatry services more than aggressive ones (73.6%, n=345 vs 32.8%, n=21, P<0.0001). Agitation  in ED and being male increased aggressive suicide attempt risk 3.5 (95% CI:1.6-7.6) and 3.2 times (95% CI:1.8-5.5), respectively.  Agitation was statistically more frequent among these patients: those on antidepressant overdose, with previous suicide attempt;  with aggressive suicide attempt; and those with confusion; and unconsciousness (P<0.05).

Conclusion: Patients who attempted suicide and whose risk of harm to others included those with: antidepressant overdose,  aggressive suicide attempt and the unconscious. Response teams should be prepared for these subgroups.

Keywords:Agitation, suicide attempt, deliberate self-harm