title: Do hospital E-codes consistently capture suicidal behaviour?
abstract: Hospital separation data are used to study suicidal behaviour; however, there is little information about the appropriateness of these data for research and planning activities. The study purpose is to examine how consistently hospital separation E-code data reflect suicidal behaviours. Expert clinicians reviewed medical records of individuals who had a separation for self-poisoning to determine whether the self-poisoning was deliberate. Agreement among clinicians was evaluated and latent class analysis performed to derive a summary estimate of the prevalence of deliberate self-poisoning. This estimate was then compared to the prevalence of deliberate self-poisoning based on the external cause of injury (E-codes). Clinicians estimated the prevalence to be 63% higher than the E-code based prevalence. Much larger discrepancies were apparent among older age groups, those whose care was primarily medical in nature and those with a longer length of hospital stay. In acute care settings, self-poisonings among the elderly may not receive adequate attention and/or documentation. Estimating the prevalence of admissions for suicidal behaviour using hospital separation data is of questionable validity, particularly among older age groups.
authors.affiliation: The Suicide Studies Unit, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, Canada M5B 1W8. rhodesa@smh.toronto.on.ca
authors.forename: Anne E
authors.initials: AE
authors.lastname: Rhodes
authors.forename: Paul S
authors.initials: PS
authors.lastname: Links
authors.forename: David L
authors.initials: DL
authors.lastname: Streiner
authors.forename: Ian
authors.initials: I
authors.lastname: Dawe
authors.forename: Dan
authors.initials: D
authors.lastname: Cass
authors.forename: Samantha
authors.initials: S
authors.lastname: Janes
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002170:Canada / Q000453:epidemiology; D004282:Documentation / Q000592:standards; D005260:Female; D006752:Hospital Planning; D006801:Humans; D038801:International Classification of Diseases; D007902:Length of Stay; D008297:Male; D008499:Medical Records / Q000145:classification*; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011041:Poisoning / Q000145:classification* / Q000523:psychology; D015995:Prevalence; D013406:Suicide, Attempted / Q000145:classification* / Q000517:prevention & control