Children who harm themselves: development of a paediatric emergency department triage tool

Emerg Med J. 2009 Jun;26(6):418-20. doi: 10.1136/emj.2008.062463.


Introduction: Children who harm, hurt or kill themselves are a significant issue for health professionals in emergency departments (ED), with over 60 000 young people presenting to ED in the UK each year following self-harm.

Methods: In response to the development of a regional integrated pathway for the management of self-harm encompassing acute care, primary care and child and adolescent mental health services, it was felt that a triage tool developed specifically for children and young people presenting with self-harm was required. A multidisciplinary group encompassing nursing, managerial and medical staff from both paediatric emergency and child and adolescent mental health services was convened to determine the priorities for this tool. In this paper the development of this paediatric-specific triage tool is discussed focusing on suicide risk, substance misuse and physical issues associated with the common presentations of self-harm in young people. The available literature is also reviewed and the multidisciplinary approach to developing a user-friendly tool is discussed.

Results: A modified risk of suicide questionnaire, the CRAFFT questionnaire, and three questions about physical manifestations of self-harm were used to form a 14-point triage/screening tool, requiring only yes/no answers.

Conclusion: A paediatric triage tool was developed that allows the more appropriate triage of young people who harm themselves and is acceptable to all stakeholders involved in their care.

MeSH terms

  • Adolescent
  • Child
  • Emergency Service, Hospital / organization & administration*
  • Humans
  • Mental Health*
  • Patient Care Team
  • Risk Assessment
  • Self-Injurious Behavior / therapy*
  • Severity of Illness Index*
  • Substance-Related Disorders / therapy
  • Suicide, Attempted / prevention & control
  • Triage / methods*