Hansen Anna, Slavova Dessi, Cooper Gena, Zummer Jaryd, Costich Julia
Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, KY, USA.
Department of Sociology, University of Kentucky, Lexington, USA.
Inj Epidemiol. 2021 Jan 8;8(1):3. doi: 10.1186/s40621-020-00293-8.
Non-suicidal self-injury and suicide attempts are increasing problems among American adolescents. This study developed a definition for identifying intentional self-harm (ISH) injuries in emergency department (ED) records coded with International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes. The definition is based on the injury-reporting framework proposed by the Centers for Disease Control and Prevention. The study sought to estimate the definition's positive predictive value (PPV), and the proportion of ISH injuries with intent to die (i.e., suicide attempt).
The study definition, based on first-valid external cause-of-injury ICD-10-CM codes X71-X83, T14.91, T36-T65, or T71, captured 207 discharge records for initial encounters for ISH in one Kentucky ED. Medical records were reviewed to confirm provider-documented diagnosis for ISH, and identify intent to die or suicide ideation. The PPV of the study definition for capturing provider-documented ISH injuries was reported with its 95% confidence interval (95% CI).
The estimated PPV for the study definition to capture ISH injuries was 88.9%, 95% CI (83.8%, 92.8%). The estimated percentage of ISH with intent to die was 45.9, 95% CI (47.1, 61.0%). The ICD-10-CM code "suicide attempt" (T14.91) captured only 7 cases, but coding guidelines restrict assignment of this code to cases in which the mechanism of the suicide attempt is unknown.
The proposed case definition supported a robust PPV for ISH injuries. Our findings add to the evidence that the current ICD-10-CM coding system and coding guidelines do not allow identification of ISH with intent to die; modifications are needed to address this issue.
非自杀性自伤和自杀未遂在美国青少年中日益成为问题。本研究制定了一个定义，用于在使用国际疾病分类第十次修订本临床修订版（ICD-10-CM）编码的急诊室（ED）记录中识别故意自我伤害（ISH）损伤。该定义基于疾病控制和预防中心提出的伤害报告框架。本研究旨在估计该定义的阳性预测值（PPV）以及有死亡意图（即自杀未遂）的ISH损伤比例。
基于首个有效的外部伤害原因ICD-10-CM编码X71-X83、T14.91、T36-T65或T71的研究定义，获取了肯塔基州一家急诊室207例ISH初次就诊的出院记录。对病历进行审查，以确认提供者记录的ISH诊断，并确定死亡意图或自杀意念。报告了该研究定义用于捕捉提供者记录的ISH损伤的PPV及其95%置信区间（95%CI）。
该研究定义捕捉ISH损伤的估计PPV为88.9%，95%CI为（83.8%，92.8%）。有死亡意图的ISH估计百分比为45.9%，95%CI为（47.1%，61.0%）。ICD-10-CM编码“自杀未遂”（T14.91）仅捕捉到7例，但编码指南将该编码的分配限制在自杀未遂机制不明的病例中。
所提出的病例定义支持对ISH损伤有较强的PPV。我们的研究结果进一步证明，当前的ICD-10-CM编码系统和编码指南无法识别有死亡意图的ISH；需要进行修改以解决这一问题。
