Self-harm Presentations That Encounter the Emergency Department in Youth (the SPEEDY Study): Rapid Risk Stratification to Inform Clinical Management

If a young person between the ages of 10 and 19 years presents to the emergency department with self-harm for the first time, the front-line clinician is obliged to assess and stratify the risk of suicide and then determine disposition and treatment.  Despite the dramatic rise in the rates of presentations to the ED for self-harm among youth across many jurisdictions, there is no consensus and no evidence-based guidelines to inform this practice.  Cutting and poisoning are the two methods used in > 90% of all ED presentations for self-harm among youth; yet it is not known which method is a more important predictor of suicide, over and above other predictors, such as age and sex.  This study will leverage a sample of ~32-54,000 over 17 years, and be the first with the specific aim to compare the suicide risk of the most frequently utilized methods of self-harm among youth presenting to the ED: cutting and poisoning. The knowledge of which method of self-harm (cutting or poisoning) confers a higher risk of suicide for youth is one of the objective factors vitally necessary to safely and effectively begin to assess and stratify the risk of suicide in a young person presenting with self-harm to the ED.  Therefore, this study has the potential to fundamentally impact how a front-line clinician (steward to scant resources in a demanding environment), reacts and provides care to a young person in the emergency department for the first time with self-harm.  Information gleaned from the addition of longitudinal trajectory modelling will further allow us to assist in developing recommendations for clinicians for management of youth self-harm according to patterns of emergency service use and their associated outcomes.