Cooper Jayne, Kapur Navneet, Dunning Joel, Guthrie Else, Appleby Louis, Mackway-Jones Kevin
Centre for Suicide Prevention, University of Manchester, Manchester, England.
Ann Emerg Med. 2006 Oct;48(4):459-66. doi: 10.1016/j.annemergmed.2006.07.944.
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.
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.
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.
Application of this simple, highly sensitive rule may facilitate assessment in the ED and help to focus psychiatric resources on patients at higher risk.
我们的目标是开发一种风险分层模型，供急诊科临床工作人员用于评估自残就诊患者。
研究对象为1997年9月1日至2001年2月28日期间在英国曼彻斯特和索尔福德的5家急诊科因自残就诊的患者。每次就诊时收集每位患者的社会、人口统计学和临床信息。利用曼彻斯特和索尔福德自残项目的数据，通过递归划分得出一个临床决策规则，以区分6个月内重复自残或随后自杀风险较高和较低的患者。来自3家急诊科的数据用于推导集。该模型用其余2家急诊科的数据进行验证。
在本研究期间收集了9086例自残患者的数据，其中17%在6个月内再次就诊，22例在6个月内自杀死亡。得出了一个包含4个问题的规则，其敏感度为94%（92.1 - 95.0%[95%置信区间]），特异度为25%（24.2 - 26.5%[95%置信区间]），用于识别重复自残或自杀风险较高的患者。
应用这个简单、高敏感度的规则可能有助于急诊科的评估，并有助于将精神科资源集中于高风险患者。
