Objectives

Suicide rates in the United States rose 35.2% from 1999-2018. As emergency department (ED) providers often have limited training in management of suicidal patients and minimal access to mental health experts, clinical practice guidelines (CPGs) may improve care for these patients. However, clinical practice guidelines that do not adhere to quality standards for development may be harmful both to patients, if they promote practices based on flawed evidence, and to ED providers, if used in malpractice claims. In 2011, the Institute of Medicine created standards to determine the trustworthiness of CPGs. This review assessed the adherence of suicide prevention CPGs, intended for the ED, to these standards. Secondary objectives were to assess the association of adherence both with first author/organization specialty (ED vs non-ED) and with inclusion of recommendations on substance use, a potent risk factor for suicide.

Methods

This is a systematic review of available suicide-prevention CPGs for the ED in both peer-reviewed and gray literature. This review followed the PRISMA standards for reporting systematic reviews.

Results

Of 22 included CPGs, the 7 ED-sponsored CPGs had higher adherence to quality standards (3.1 vs 2.4) and included the highest-rated CPG (ICAR²E) identified by this review. Regardless of specialty, nearly all CPGs included some mention of identifying or managing substance use.

Conclusions

Most suicide prevention CPGs intended for the ED are written by non-ED first authors or organizations and have low adherence to quality standards. Future CPGs should be developed with more scientific rigor, include a multidisciplinary writing group, and be created by authors working in the practice environment to which the CPG applies.

中文翻译：

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遵守急诊科自杀预防指南的制定建议：系统评价

目标

从 1999 年到 2018 年，美国的自杀率上升了 35.2%。由于急诊科 (ED) 提供者在管理自杀患者方面的培训通常有限，而且很少能接触到心理健康专家，因此临床实践指南 (CPG) 可能会改善对这些患者的护理。然而，不符合开发质量标准的临床实践指南可能对患者（如果它们基于有缺陷的证据促进实践）和 ED 提供者（如果用于医疗事故索赔）有害。2011 年，医学研究所制定了标准来确定 CPG 的可信度。该审查评估了针对 ED 的自杀预防 CPG 对这些标准的遵守情况。

方法

这是对同行评审和灰色文献中可用的 ED 自杀预防 CPG 的系统回顾。本综述遵循 PRISMA 报告系统综述的标准。

结果

在包括的 22 个 CPG 中，ED 赞助的 7 个 CPG 对质量标准的遵守程度更高（3.1 对 2.4），并且包括本次审查确定的最高评级的 CPG (ICAR ² E)。无论专业如何，几乎所有 CPG 都提到了识别或管理物质使用。

结论

大多数用于 ED 的自杀预防 CPG 是由非 ED 第一作者或组织编写的，并且对质量标准的遵守程度较低。未来的 CPG 应该更加科学严谨地开发，包括一个多学科的写作小组，并由在 CPG 适用的实践环境中工作的作者创建。