Stanley Barbara, Currier Glenn W, Chesin Megan, Chaudhury Sadia, Jager-Hyman Shari, Gafalvy Hanga, Brown Gregory K
1 Department of Psychiatry, Columbia University College of Physicians & Surgeons and New York State Psychiatric Institute, Molecular Imaging and Neuropathology Division, New York, NY, USA.
2 Department of Psychiatry, University of South Florida, Tampa, FL, USA.
Crisis. 2018 Sep;39(5):318-325. doi: 10.1027/0227-5910/a000499. Epub 2017 Dec 19.
External causes of injury codes (E-codes) are used in administrative and claims databases for billing and often employed to estimate the number of self-injury visits to emergency departments (EDs).
This study assessed the accuracy of E-codes using standardized, independently administered research assessments at the time of ED visits.
We recruited 254 patients at three psychiatric emergency departments in the United States between 2007 and 2011, who completed research assessments after presenting for suicide-related concerns and were classified as suicide attempters (50.4%, n = 128), nonsuicidal self-injurers (11.8%, n = 30), psychiatric controls (29.9%, n = 76), or interrupted suicide attempters (7.8%, n = 20). These classifications were compared with their E-code classifications.
Of the participants, 21.7% (55/254) received an E-code. In all, 36.7% of research-classified suicide attempters and 26.7% of research-classified nonsuicidal self-injurers received self-inflicted injury E-codes. Those who did not receive an E-code but should have based on the research assessments had more severe psychopathology, more Axis I diagnoses, more suicide attempts, and greater suicidal ideation.
The sample came from three large academic medical centers and these findings may not be generalizable to all EDs.
The frequency of ED visits for self-inflicted injury is much greater than current figures indicate and should be increased threefold.
伤害外部原因编码（E编码）用于行政和理赔数据库以进行计费，并且常被用于估计急诊部门（ED）自残就诊的数量。
本研究在急诊就诊时使用标准化、独立管理的研究评估来评估E编码的准确性。
2007年至2011年期间，我们在美国的三个精神科急诊部门招募了254名患者，这些患者在因自杀相关问题就诊后完成了研究评估，并被分类为自杀未遂者（50.4%，n = 128）、非自杀性自残者（11.8%，n = 30）、精神科对照者（29.9%，n = 76）或自杀未遂中断者（7.8%，n = 20）。将这些分类与他们的E编码分类进行比较。
参与者中，21.7%（55/254）获得了E编码。总体而言，研究分类为自杀未遂者中有36.7%以及研究分类为非自杀性自残者中有26.7%获得了自残伤害E编码。那些未获得E编码但根据研究评估应该获得的患者有更严重的精神病理学问题、更多的轴I诊断、更多的自杀未遂次数以及更强烈的自杀意念。
样本来自三个大型学术医疗中心，这些发现可能不适用于所有急诊部门。
自残急诊就诊的频率远高于当前数据所显示的，应提高三倍。
