Division of Pediatric Emergency Medicine, IWK Health Emergency Department, Dalhousie University, Halifax, NS, Canada.
Research Methods Unit, Nova Scotia Health, Halifax, NS, Canada.
CJEM. 2024 Apr;26(4):259-265. doi: 10.1007/s43678-024-00657-9. Epub 2024 Apr 2.
Our primary objective was to determine agreement between non-suicidal self-injury recorded at triage and during subsequent mental health assessment. The secondary objective was to describe patients who reported non-suicidal self-injury.
This is a health records review of patients aged 12-18 years who had an Emergency Mental Health Triage form on their health record from an ED visit June 1, 2017-May 31, 2018. We excluded patients with diagnoses of autism spectrum disorder or schizophrenia. We abstracted data from the Mental Health Triage form, Emergency Mental Health and Addictions Service Assessment forms and Assessment of Suicide and Risk Inventory. We calculated Cohen's Kappa coefficient, sensitivity, and negative predictive value to describe the extent to which the forms agreed and the performance of triage for identifying non-suicidal self-injury. We compared the cohort who reported non-suicidal self-injury with those who did not, using t-tests, Wilcoxon rank-sum tests, and chi-square tests.
We screened 955 ED visits and included 914 ED visits where 558 (58.4%) reported a history of non-suicidal self-injury. There were significantly more females in the group reporting non-suicidal self-injury (82.1%, n = 458) compared to the group not reporting non-suicidal self-injury (45.8%, n = 163). Patients reporting non-suicidal self-injury did so in triage and detailed Mental Health Assessment 64.7% of the time (Cohen's Kappa Coefficient 0.6); triage had sensitivity of 71.5% (95% CI 67.3-75.4) and negative predictive value of 71.2% (95% CI 68.2-74.0). Cutting was the most common method of non-suicidal self-injury (80.3%).
Screening at triage was moderately effective in identifying non-suicidal self-injury compared to a detailed assessment by a specialised mental health team. More than half of children and adolescents with a mental health-related concern in our ED reported a history of non-suicidal self-injury, most of which were female. This symptom is important for delineating patients' coping strategies.
我们的主要目的是确定分诊时记录的非自杀性自伤与随后的心理健康评估之间的一致性。次要目的是描述报告非自杀性自伤的患者。
这是一项对 2017 年 6 月 1 日至 2018 年 5 月 31 日期间在急诊科就诊的 12-18 岁患者的健康记录进行的回顾性研究。我们排除了患有自闭症谱系障碍或精神分裂症诊断的患者。我们从精神健康分诊表、精神健康和成瘾急诊评估表以及自杀和风险评估量表中提取数据。我们计算了 Cohen's Kappa 系数、敏感性和阴性预测值，以描述这些表格的一致性程度以及分诊对识别非自杀性自伤的性能。我们使用 t 检验、Wilcoxon 秩和检验和卡方检验比较了报告非自杀性自伤的队列和未报告非自杀性自伤的队列。
我们筛选了 955 次急诊就诊，其中 914 次就诊中 558 次（58.4%）报告有非自杀性自伤史。在报告非自杀性自伤的组中，女性明显多于未报告非自杀性自伤的组（82.1%，n=458 比 45.8%，n=163）。报告非自杀性自伤的患者在分诊和详细的心理健康评估中报告自伤的比例为 64.7%（Cohen's Kappa 系数 0.6）；分诊的敏感性为 71.5%（95%CI 67.3-75.4），阴性预测值为 71.2%（95%CI 68.2-74.0）。切割是非自杀性自伤最常见的方法（80.3%）。
与专门的心理健康团队进行详细评估相比，分诊时的筛查在识别非自杀性自伤方面具有中等效果。我们急诊科有心理健康问题的儿童和青少年中，超过一半报告有非自杀性自伤史，其中大多数为女性。这种症状对于描绘患者的应对策略很重要。
