Suicidal Ideation in Pediatric Orthopaedic Patients.

Background: Suicide is the second leading cause of death among American children aged 10 to 18 years, and those with medical conditions have a 20% increase in suicidal ideation (SI) relative to healthy peers. Despite this, suicidality in children with musculoskeletal problems is largely unstudied. This study aims to determine the prevalence of SI in pediatric orthopaedic patients and identify risk factors for suicidality. Methods: A retrospective review of patients aged older than 10 years presenting for outpatient orthopaedic evaluation to a tertiary pediatric institution over a 1-year period was conducted. Demographic information, chief complaint, pain symptomatology, treatment history, primary orthopaedic diagnosis, and responses on the Ask Suicide-Screening Questionnaire were reviewed. Results: Of 19,631 individual patient encounters, 470 children (2.4%) endorsed SI with 23 (4.9%) experiencing active SI. Patients endorsing suicidality were predominantly assigned female sex at birth (66.2%), Black (2.9%), with a mean age of 14.1 years. They were also more likely to present with a chief complaint of pain (2.7% vs. 2.2%, p = 0.0188) and were ultimately more likely to receive a nonstructural, nonmechanical pain diagnosis (4.4% vs. 2.1%, p < 0.0001). Those presenting for pain who screened positive for SI were more likely to characterize their pain as persistent/chronic than acute (59.3% vs. 40.7% p < 0.0001). Multivariate analyses revealed that patients taking psychotropic medications (odds ratio [OR] = 3.4, 95% confidence interval [CI]: 2.6-4.3) and carrying a preexisting psychological diagnosis (OR = 2.5, 95% CI: 2.0-3.1) were more likely to report SI. Patients with underlying mental health disorders presenting with a chief complaint of pain without an identifiable structural/mechanical etiology were 2.5 times more likely to screen positive for SI (OR = 2.5, 95% CI: 2.0-3.1). Conclusion: SI was identified in 2.4% of adolescent pediatric orthopaedic patients presenting for outpatient care. Black female patients with chronic pain and preexisting mental health diagnoses appear be at higher risk. Level of Evidence: Level III. See Instructions for Authors for a complete description of levels of evidence.