An emergency department medical record review for adolescent intentional self-harm injuries
Abstract Background 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...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-01-01
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| Series: | Injury Epidemiology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40621-020-00293-8 |
| _version_ | 1818600151673995264 |
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| author | Anna Hansen Dessi Slavova Gena Cooper Jaryd Zummer Julia Costich |
| author_facet | Anna Hansen Dessi Slavova Gena Cooper Jaryd Zummer Julia Costich |
| author_sort | Anna Hansen |
| collection | DOAJ |
| description | Abstract Background 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). Methods 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). Results 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. Conclusions 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. |
| first_indexed | 2024-12-16T12:30:56Z |
| format | Article |
| id | doaj.art-80f2968d6fcb4cb88ca598f8f247935f |
| institution | Directory Open Access Journal |
| issn | 2197-1714 |
| language | English |
| last_indexed | 2024-12-16T12:30:56Z |
| publishDate | 2021-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Injury Epidemiology |
| spelling | doaj.art-80f2968d6fcb4cb88ca598f8f247935f2022-12-21T22:31:41ZengBMCInjury Epidemiology2197-17142021-01-01811810.1186/s40621-020-00293-8An emergency department medical record review for adolescent intentional self-harm injuriesAnna Hansen0Dessi Slavova1Gena Cooper2Jaryd Zummer3Julia Costich4Kentucky Injury Prevention and Research Center, University of KentuckyCollege of Medicine, University of KentuckyDepartment of Emergency Medicine, College of Medicine, University of KentuckyDepartment of Emergency Medicine, College of Medicine, University of KentuckyKentucky Injury Prevention and Research Center, University of KentuckyAbstract Background 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). Methods 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). Results 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. Conclusions 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.https://doi.org/10.1186/s40621-020-00293-8Intentional self-harmAdolescenceSuicidePopulation surveillanceICD-10-CM |
| spellingShingle | Anna Hansen Dessi Slavova Gena Cooper Jaryd Zummer Julia Costich An emergency department medical record review for adolescent intentional self-harm injuries Injury Epidemiology Intentional self-harm Adolescence Suicide Population surveillance ICD-10-CM |
| title | An emergency department medical record review for adolescent intentional self-harm injuries |
| title_full | An emergency department medical record review for adolescent intentional self-harm injuries |
| title_fullStr | An emergency department medical record review for adolescent intentional self-harm injuries |
| title_full_unstemmed | An emergency department medical record review for adolescent intentional self-harm injuries |
| title_short | An emergency department medical record review for adolescent intentional self-harm injuries |
| title_sort | emergency department medical record review for adolescent intentional self harm injuries |
| topic | Intentional self-harm Adolescence Suicide Population surveillance ICD-10-CM |
| url | https://doi.org/10.1186/s40621-020-00293-8 |
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