Saunders Kate, Brand Fiona, Lascelles Karen, Hawton Keith
Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford, UK.
Deliberate Self-Harm and Psychiatric Liaison Service, Barnes Unit, Oxford Health NHS Foundation Trust, The John Radcliffe Hospital, Oxford, UK.
Emerg Med J. 2014 Oct;31(10):796-8. doi: 10.1136/emermed-2013-202781. Epub 2013 Jul 29.
The SADPERSONS Scale is commonly used as a screening tool for suicide risk in those who have self-harmed. It is also used to determine psychiatric treatment needs in those presenting to emergency departments. To date, there have been relatively few studies exploring the utility of SADPERSONS in this context.
To determine whether the SADPERSONS Scale accurately predicts psychiatric hospital admission, psychiatric aftercare and repetition of self-harm at presentation to the emergency department following self-harm.
SADPERSONS scores were recorded for 126 consecutive admissions to a general hospital emergency department. Clinical management outcomes following assessment were recorded, including psychiatric hospital admission, community psychiatric aftercare and repetition of self-harm in the following 6 months.
Psychiatric hospital admission was required in five cases (4.0%) and community psychiatric aftercare in 70 (55.5%). 31 patients (24.6%) repeated self-harm. While the specificity of the SADPERSONS scores was greater than 90% for all outcomes, sensitivity for admission was only 2.0%, for community aftercare was 5.8% and for repetition of self-harm in the following 6 months was just 6.6%.
For the purposes of suicide prevention, a low false negative rate is essential. SADPERSONS failed to identify the majority of those either requiring psychiatric admission or community psychiatric aftercare, or to predict repetition of self-harm. The scale should not be used to screen self-harm patients presenting to general hospitals. Greater emphasis should be placed on clinical assessment which takes account of the individual and dynamic nature of risk assessment.
SADPERSONS量表通常用作自残者自杀风险的筛查工具。它也用于确定前往急诊科就诊者的精神治疗需求。迄今为止，在这种情况下探索SADPERSONS量表效用的研究相对较少。
确定SADPERSONS量表能否准确预测自残后前往急诊科就诊时的精神科住院治疗、精神科后续护理以及自残行为的重复发生情况。
对一家综合医院急诊科连续收治的126例患者记录SADPERSONS评分。记录评估后的临床管理结果，包括精神科住院治疗、社区精神科后续护理以及接下来6个月内的自残行为重复发生情况。
5例（4.0%）需要精神科住院治疗，70例（55.5%）需要社区精神科后续护理。31例患者（24.6%）再次自残。虽然SADPERSONS评分对所有结果的特异性均大于90%，但对住院治疗的敏感性仅为2.0%，对社区后续护理的敏感性为5.8%，对接下来6个月内自残行为重复发生情况的敏感性仅为6.6%。
为预防自杀，低假阴性率至关重要。SADPERSONS量表未能识别出大多数需要精神科住院治疗或社区精神科后续护理的患者，也无法预测自残行为的重复发生。该量表不应被用于筛查前往综合医院就诊的自残患者。应更加重视考虑风险评估的个体性和动态性的临床评估。
