Dennis M, Beach M, Evans P A, Winston A, Friedman T
Division of Psychiatry for the Elderly, University of Leicester, Leicester General Hospital.
J Accid Emerg Med. 1997 Sep;14(5):311-5. doi: 10.1136/emj.14.5.311.
To examine the adequacy of assessment and management of deliberate self harm (DSH) undertaken by accident and emergency (A&E) medical staff.
The records for attendances to the Leicester Royal Infirmary A&E department with a diagnosis of "self inflicted" injury for the 12 month period April 1994 to March 1995 were scrutinised. If the episode was identified as DSH, then assessment and management were examined, using an instrument based on the Royal College of Psychiatrists' standards of service for the general hospital management of adult DSH.
There were 934 episodes of DSH involving 854 patients. The mean age was 32 (SD 14.2), with an even sex distribution. Overdose was by far the most common method of DSH (91.5%). Information concerning suicide intent was documented in 70% of cases, and psychiatric history in 67%. Less information was recorded for medical history (50%), mental state (51%), recent stress (55%), or previous DSH (47%), and only 23% had an assessment of risk of further DSH. Very little was recorded concerning alcohol or substance misuse. In 291 cases (31%), the patient was discharged directly home by A&E medical staff, and 50 of these were referred for psychiatric outpatient follow up; 210 (23%) were referred for specialist assessment in the department and 423 (45.5%) were admitted to medical/surgical wards. The frequency with which information was recorded varied significantly between outcome groups. At night A&E staff were far more likely to discharge a patient home themselves than refer for specialist assessment (P << 0.001).
With over half the sample not admitted, the responsibility for the initial risk assessment lies with A&E medical staff. The study reveals a need for improved planning and delivery of services.
检查急诊医护人员对蓄意自伤（DSH）的评估和处理是否充分。
仔细审查了1994年4月至1995年3月这12个月期间莱斯特皇家医院急诊科诊断为“自残”损伤的就诊记录。如果该事件被认定为DSH，则使用基于皇家精神科医学院关于成人DSH综合医院管理服务标准的工具对评估和处理情况进行检查。
共有934起DSH事件，涉及854名患者。平均年龄为32岁（标准差14.2），男女分布均匀。服药过量是迄今为止最常见的DSH方式（91.5%）。70%的病例记录了自杀意图信息，67%记录了精神病史。关于病史（50%）、精神状态（51%）、近期压力（55%）或既往DSH（47%）的记录较少，只有23%对再次发生DSH的风险进行了评估。关于酒精或药物滥用的记录很少。在291例（31%）中，患者由急诊医护人员直接送回家，其中50例被转介至精神科门诊进行随访；210例（23%）被转介至科室进行专科评估，423例（45.5%）被收入内科/外科病房。不同结局组之间信息记录的频率差异显著。夜间，急诊医护人员将患者直接送回家的可能性远高于转介至专科评估（P << 0.001）。
由于超过一半的样本未被收治，初始风险评估的责任在于急诊医护人员。该研究表明需要改进服务的规划和提供。
