Emergency departments (EDs) are often the adolescent suicide attempter’s first point of contact with the medical system. After reviewing the characteristics of adolescent suicide attempters treated in EDs, a procedure for the evaluation of a variety of suicide-specific factors when planning the disposition of adolescents who attempt suicide is discussed. Current suicidal ideation, intent, history of suicidal behavior, reasons for the attempt, common stressful events that might trigger another suicidal act in a vulnerable adolescent, as well as reasons for future hope are assessed. Because it is difficult to predict adolescents at risk for repeat attempts, emphasis is placed on hospitalizing high risk patients and enhancing the probability that those appropriate for discharge receive psychiatric aftercare in the community. Clin Ped Emerg Med 5:154-163. © 2004 Elsevier Inc. All rights reserved. Assessment and Disposition Planning for Adolescent Suicide Attempters Treated in the Emergency Department By Anthony Spirito, PhD, and William Lewander, MD PROVIDENCE, RHODE ISLAND E MERGENCY DEPARTMENTS ARE OFTEN THE adolescent sui- cide attempter’s first point of contact with the medical system. In many instances, adolescent suicide attempters are medically stabilized in the emergency department (ED) and then referred for psychiatric care. This referral is a result of either an evaluation by a psychiatric consultant, the ED physician, or both. In either case, the ED physician who writes the discharge orders must try to answer several questions before discharging the adolescent suicide attempter including, “Is the patient at risk for completing suicide in the near future?”, “Is the patient at risk for reattempting suicide?”, and “What is the likelihood that the patient will follow through with the referral for outpatient psychiatric care?” The literature perti- nent to these 3 questions will be discussed after reviewing the prevalence of adolescent suicide attempts and characteristics of adolescent suicide attempters treated in EDs. The article will con- clude with a guide to assessing suicidal risk for the nonpsychiatric physician. Rates of Medically Serious Suicide Attempts by Adolescents Recent nationwide surveys suggest that each year approxi- mately 21% of adolescents seriously consider attempting suicide, 16% develop a suicide plan, 7.7% attempt suicide, and 2.6% of adolescents require emergency medical treatment for their at- tempts. 1 Data collected using the Youth Risk Behavior Surveil- From Rhode Island Hospital, and Brown Medical School, Brown University. Address reprint requests to: Anthony Spirito, PhD, Brown University, CAAS, Box G-BH, Providence, RI 02912. E-mail: Anthony_Spirito@Brown.edu. 1522-8401/$—see front matter © 2004 Elsevier Inc. All rights reserved. doi:10.1016/j.cpem.2004.05.004 154 ASSESSMENT AND DISPOSITION PLANNING FOR ADOLESCENT SUICIDE ATTEMPTERS / SPIRITO AND LEWANDER