Centre for Mental Health and Safety, Manchester Academic Health Science Centre, University of Manchester, Manchester, England.
Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England.
BMC Psychiatry. 2018 Apr 25;18(1):113. doi: 10.1186/s12888-018-1693-z.
Risk scales are used widely in the management of patients presenting to hospital following self-harm. However, there is evidence that their diagnostic accuracy in predicting repeat self-harm is limited. Their predictive accuracy in population settings, and in identifying those at highest risk of suicide is not known.
We compared the predictive accuracy of the Manchester Self-Harm Rule (MSHR), ReACT Self-Harm Rule (ReACT), SAD PERSONS Scale (SPS) and Modified SAD PERSONS Scale (MSPS) in an unselected sample of patients attending hospital following self-harm. Data on 4000 episodes of self-harm presenting to Emergency Departments (ED) between 2010 and 2012 were obtained from four established monitoring systems in England. Episodes were assigned a risk category for each scale and followed up for 6 months.
The episode-based repeat rate was 28% (1133/4000) and the incidence of suicide was 0.5% (18/3962). The MSHR and ReACT performed with high sensitivity (98% and 94% respectively) and low specificity (15% and 23%). The SPS and the MSPS performed with relatively low sensitivity (24-29% and 9-12% respectively) and high specificity (76-77% and 90%). The area under the curve was 71% for both MSHR and ReACT, 51% for SPS and 49% for MSPS. Differences in predictive accuracy by subgroup were small. The scales were less accurate at predicting suicide than repeat self-harm.
The scales failed to accurately predict repeat self-harm and suicide. The findings support existing clinical guidance not to use risk classification scales alone to determine treatment or predict future risk.
风险量表广泛应用于管理因自残而到医院就诊的患者。然而，有证据表明，它们在预测重复自残方面的诊断准确性有限。它们在人群环境中的预测准确性，以及识别自杀风险最高的人，目前尚不清楚。
我们比较了曼彻斯特自伤规则（MSHR）、反应自伤规则（ReACT）、SAD PERSONS 量表（SPS）和改良 SAD PERSONS 量表（MSPS）在未经选择的因自残而到医院就诊的患者样本中的预测准确性。我们从英国四个已建立的监测系统中获得了 2010 年至 2012 年间急诊科 4000 例自残发作的数据。根据每个量表为每个发作分配一个风险类别，并进行了 6 个月的随访。
基于发作的复发率为 28%（1133/4000），自杀发生率为 0.5%（18/3962）。MSHR 和 ReACT 的灵敏度均较高（分别为 98%和 94%），特异性较低（分别为 15%和 23%）。SPS 和 MSPS 的灵敏度相对较低（分别为 24-29%和 9-12%），特异性较高（分别为 76-77%和 90%）。MSHR 和 ReACT 的曲线下面积均为 71%，SPS 为 51%，MSPS 为 49%。亚组间预测准确性的差异较小。这些量表在预测自杀方面的准确性不及预测重复自残。
这些量表未能准确预测重复自残和自杀。研究结果支持现有的临床指南，即不单独使用风险分类量表来确定治疗或预测未来风险。
