A clinical tool for assessing risk after self-harm.
OBJECTIVE
Our aim is to develop a risk-stratification model for use by emergency department (ED) clinical staff in the assessment of patients attending with self-harm.


METHODS
Participants were patients who attended 5 EDs in Manchester and Salford, England, after self-harm between September 1, 1997, and February 28, 2001. Social, demographic, and clinical information was collected for each patient at each attendance. With data from the Manchester and Salford Self-Harm Project, a clinical decision rule was derived by using recursive partitioning to discriminate between patients at higher and lower risk of repetition or subsequent suicide occurring within 6 months. Data from 3 EDs were used for the derivation set. The model was validated with data from the remaining 2 EDs.


RESULTS
Data for 9,086 patients who presented with self-harm were collected during this study period, including 17% that reattended within 6 months and 22 patients who died by suicide within 6 months. A 4-question rule, with a sensitivity of 94% (92.1-95.0% [95% confidence interval]) and specificity of 25% (24.2-26.5% [95% confidence interval]), was derived to identify patients at higher risk of repetition or suicide.


CONCLUSIONS
Application of this simple, highly sensitive rule may facilitate assessment in the ED and help to focus psychiatric resources on patients at higher risk.
Cooper
Jayne
J
Centre for Suicide Prevention, University of Manchester, Manchester, England. jayne.cooper@manchester.ac.uk
Kapur
Navneet
N
Dunning
Joel
J
Guthrie
Else
E
Appleby
Louis
L
Mackway-Jones
Kevin
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001569:Benzodiazepines / Q000506:poisoning; D019090:Case Management; D016009:Chi-Square Distribution; D002648:Child; D003663:Decision Trees; D062787:Drug Overdose; D004636:Emergency Service, Hospital; D004637:Emergency Services, Psychiatric; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D008962:Models, Theoretical; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D012306:Risk; D018570:Risk Assessment; D016728:Self-Injurious Behavior / Q000453:epidemiology* / Q000517:prevention & control / Q000523:psychology; D012680:Sensitivity and Specificity; D013406:Suicide, Attempted / Q000517:prevention & control / Q000523:psychology / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014505:Urban Population; D014951:Wounds, Stab / Q000453:epidemiology; D000092864:Suicide Prevention
D001569:Benzodiazepines