A comparison between clinicians' assessment and the Manchester Self-Harm Rule: a cohort study.
As identifying patients at risk of subsequent suicidal behaviour is a key goal of assessment, a cohort study of presentations to five emergency departments following episodes of self-harm was carried out. We compared the accuracy of the prediction of subsequent self-harm within 6 months between global clinical assessments and the Manchester Self-harm Rule. Sensitivity, specificity, and positive and negative predictive values with 95% confidence intervals (CI) were calculated. Global clinical assessments and the rule had a sensitivity of 85% (CI 83 to 87) versus 94% (CI 92% to 95%), specificity of 38% (CI 37% to 39%) versus 26% (CI 24% to 27%), a positive predictive value of 22% (CI 21% to 23%) versus 21% (CI 19% to 21%) and a negative predictive value of 92% (CI 91% to 93%) versus 96% (CI 94% to 96%). The accuracy of predicting short-term repetition of self-harm by clinicians could be improved by incorporating this simple rule into their assessment.
Cooper
Jayne
J
Centre for Suicide Prevention, University of Manchester, 7th Floor, Williamson Building, Oxford Road, Manchester M13 9PL, UK. jayne.cooper@manchester.ac.uk
Kapur
Navneet
N
Mackway-Jones
Kevin
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015331:Cohort Studies; D003661:Decision Support Techniques; D004635:Emergency Medicine / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D000092864:Suicide Prevention