Assessment of suicide attempts in an emergency service of a General Hospital

2011 ◽  
Vol 26 (S2) ◽  
pp. 1635-1635
Author(s):  
M. Pérez García ◽  
B. Portela Traba ◽  
A. Mozos Ansorena ◽  
J.M. Cornes Iglesias ◽  
M. Páramo Fernandez
Keyword(s):  
Emergency Department ◽  
Suicide Attempt ◽  
Drug Overdose ◽  
Emergency Service ◽  
Suicide Attempts ◽  
Psychiatric Emergency ◽  
Psychiatric Ward ◽  
Psychiatric Emergency Service ◽  
Icd 10 ◽  
History Of

IntroductionThere is a high frequency of attendance at emergency medical service for suicide attempts.ObjectivesDetermine the type of urgency for suicide attempt in our country.Material and methodsThe present study treats of suicide attempts (n = 248) attended by the Psychiatric Emergency Service of Hospital in our city between 2004–2008. The diagnoses were made by clinical interview following ICD-10 criteria.Results248 suicide attempts (60% women), with age between 15 and 88 years.There are equal proportions of singles and married (a 38%). 53% live with couple with/without children, 30%live with parents and a 10%live alone. >55% of patients have a middle education and socioeconomic level. The average time from suicide attempt until the assessment in the emergency department is 2.71 ± 3.64 hours. The day of the week with more assistance for this reason is Monday. Also it's observed an increase in the months between May and October. The cases are uniformly distributed throughout the month, although there is a decrease in the number of cases in the initial and final days of the month. 60% of patients haven’t history of previous attempts and use an only method that is drug overdose. Personality disorders are the most frequent diagnose and 44% patients need an internment in a psychiatric ward.ConclusionsProfile of the patient who makes a suicide attempt and that is evaluated in the Psychiatric Emergency Service of our Hospital: woman 36 years old, married/with couple and lives with him/her. She comes to emergency department in the first 4 hours after the drug overdose. She hasn’t history of previous attempts.She is diagnosed of emotionally unstable personality disorder.

scholarly journals Positive Predictive Value of ICD-10-CM Definitions for Adolescent Intentional Self-Harm: An Emergency Department Medical Record Review

2020 ◽  
Author(s):  
Anna Hansen ◽  
Dessi Slavova ◽  
Gena Cooper ◽  
Jaryd Zummer ◽  
Julia F Costich
Keyword(s):  
Emergency Department ◽  
Suicide Attempt ◽  
Positive Predictive Value ◽  
Medical Record ◽  
Predictive Value ◽  
Suicide Attempts ◽  
Pediatric Population ◽  
Icd 10 ◽  
Self Harm ◽  
Coding Guidelines

Abstract Background Non-suicidal self-injury and suicide attempts are increasing problems among American adolescents. This study proposed a definition for identifying intentional self-harm injuries (ISHIs) in emergency department (ED) records coded with International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes and sought to estimate: (1) the definition’s positive predictive value (PPV) in a pediatric population treated in one Kentucky ED, and (2) the proportion of Intentional self-harm injuries (ISHIs) with intent to die (i.e., suicide attempt) that cannot be captured by ICD-10-CM codes and can only be identified by a medical record abstraction. Methods The study definition captured initial encounters for ISHIs based on first valid external cause-of-injury self-harm codes in the ICD-10-CM range X71-X83, T14.91, T36-T65, or T71. Medical records for a random sample of 207 ED discharge records were reviewed following a specified protocol. The PPV for the study definition was reported with its 95% confidence interval (95%CI). Results The estimated PPV for the study definition’s ability to capture true ISHIs was 88.9%, 95%CI (83.8%, 92.8%). The estimated percentage of ISHIs 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 allow assignment of this code only when the mechanism of the suicide attempt is unknown. Conclusions This study demonstrated a critical shortcoming in U.S. morbidity surveillance. The ICD-10-CM coding system and coding guidelines do not allow accurate identification of ISHIs with intent to die; modifications are needed to address this issue.

scholarly journals An emergency department medical record review for adolescent intentional self-harm injuries

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Anna Hansen ◽  
Dessi Slavova ◽  
Gena Cooper ◽  
Jaryd Zummer ◽  
Julia Costich
Keyword(s):  
Emergency Department ◽  
Suicide Attempt ◽  
Suicide Ideation ◽  
Suicide Attempts ◽  
International Classification Of Diseases ◽  
Case Definition ◽  
Coding System ◽  
Icd 10 ◽  
Self Harm ◽  
Coding Guidelines

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.

scholarly journals Substance Misuse in the Psychiatric Emergency Service; A Descriptive Study

2014 ◽  
Vol 8 ◽  
pp. SART.S13375
Author(s):  
Yves Chaput ◽  
Marie-Josέe Lebel ◽  
Lucie Beaulieu ◽  
Michel Paradis ◽  
Edith Labonté
Keyword(s):  
Nursing Staff ◽  
Emergency Service ◽  
Depressive Disorders ◽  
Substance Misuse ◽  
Previous History ◽  
Psychiatric Emergency ◽  
Screening Tools ◽  
Subjective Rating ◽  
Psychiatric Emergency Service ◽  
History Of

Substance misuse is frequently encountered in the psychiatric emergency service (PES) and may take many forms, ranging from formal DSM-IV diagnoses to less obvious entities such as hazardous consumption. Detecting such patients using traditional screening instruments has proved problematic. We therefore undertook this study to more fully characterize substance misuse in the PES and to determine whether certain variables might help better screen these patients. We used a prospectively acquired database of over 18,000 visits made to four PESs during a 2-year period in the province of Quebec, Canada. One of the variables acquired was a subjective rating by the nursing staff as to whether substance misuse was a contributing factor to the visit (graded as direct, indirect, or not at all). Substance misuse accounted for 21% of all diagnoses and alcohol was the most frequent substance used. Patients were divided into those with primary (PSM), comorbid (CSM) or no substance misuse (NSM). Depressive disorders were the most frequent primary diagnoses in CSM, whereas personality and substance misuse disorders were frequent secondary diagnoses in PSM. Although many variables significantly differentiated the three groups, few were sufficiently detailed to be used as potential screening tools. Those situations that did have sufficient details included those with a previous history of substance misuse, substance misuse within 48 hours of the visit, and visits graded by the nursing staff as being directly and/or indirectly related to substance misuse. Variables related to substance misuse itself were the primary predictors of PSM and, less significantly, CSM. The nursing staff rating, although promising, was obtained in less than 30% of all visits, rendering its practical use difficult to assess.

Aggressivity and Atmosphere in a General Hospital Psychiatric Emergency Service

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
P.M. Furlan ◽  
R.L. Picci
Keyword(s):  
General Hospital ◽  
Emergency Service ◽  
Psychiatric Emergency ◽  
Psychiatric Ward ◽  
Point Scale ◽  
Psychiatric Emergency Service ◽  
Ward Atmosphere ◽  
Risk Probability ◽  
Psychiatric Staff ◽  
Hospital Wards

This research identifies possible indicators of risk of aggressivity in a general hospital psychiatric ward going beyond the analysis of the episode in itself. We suggest that behaviour can be strongly conditioned by the milieu (which is organised in a similar way to other hospital wards) especially since we have found that violence is not correlated with diagnosis. We have used the Overt Aggressivity Scale and our own Ward Atmosphere Evaluation Scale (currently under validation) in order to identify those features which increase or reduce the risk of violent episodes. Factorial analysis and the study of risk probability have enabled us to create a 12 point scale (from red alert to yellow calm) of the probability/possibility of violent episodes. the scale allows psychiatric staff to assess the risk of aggressivity and consequently to modify the management and organisation of the ward if necessary (including emotional and psychological attitudes of the staff).

ICD-10 mental and behavioural disorders due to use of crack and powder cocaine as treated at a public psychiatric emergency service: An analysis of visit predictors

2014 ◽  
Vol 26 (4) ◽  
pp. 508-514 ◽  
Author(s):  
Thalita Alves da Cruz ◽  
Gustavo Nunes da Cunha ◽  
Vinicius Papa Milani de Moraes ◽  
Renata Massarini ◽  
Camila Mie Kawata Yoshida ◽  
...  
Keyword(s):  
Emergency Service ◽  
Psychiatric Emergency ◽  
Behavioural Disorders ◽  
Psychiatric Emergency Service ◽  
Icd 10

scholarly journals Emotional Reactivity and Family-Related Factors Associated With Self-Injurious Behavior in Adolescents Presenting to a Child and Adolescent Psychiatric Emergency Service

2021 ◽  
Vol 12 ◽  
Author(s):  
Stephanie Kandsperger ◽  
Irina Jarvers ◽  
Angelika Ecker ◽  
Daniel Schleicher ◽  
Joseph Madurkay ◽  
...  
Keyword(s):  
Emotion Regulation ◽  
Suicidal Ideation ◽  
Emergency Service ◽  
Emotional Reactivity ◽  
Child And Adolescent ◽  
Psychiatric Emergency ◽  
Psychiatric Emergency Service ◽  
Significant Difference ◽  
History Of ◽  
Acute Crisis

Background: Adolescents presenting in a child and adolescent psychiatric emergency service show various psychiatric disturbances, most commonly suicidal ideation, suicide attempts, and non-suicidal self-injury (NSSI). It was postulated that especially disturbed emotion regulation contributes to self-injurious behavior of young people. This study aims to investigate the relevance of emotional reactivity (ER), as part of emotion regulation, during an acute crisis, how it relates to self-injurious behavior reinforcement and how a family as well as peers' history of self-injurious behavior are associated with self-injurious behavior of presenting adolescents. Additionally, crisis-triggering background factors were evaluated from the perspective of patients and their caregivers.Methods: A consecutive sample of 86 adolescents aged 11–18 years presenting to the emergency outpatient department due to self-injurious thoughts and behavior received a pretreatment psychiatric evaluation. Among other psychometric measures and structured clinical interviews, ER was measured via the Emotion Reactivity Scale (ERS). Family-related aspects were collected both through evaluation of history and through questionnaires filled in by custodians or parents.Results: Data analysis revealed that suicidal ideation was significantly related to family history with self-injurious behavior in comparison with a family background without such a history. A significant positive correlation was apparent between the ERS sensitivity score and occurrence of NSSI within the past year. A relationship between the ERS and distinct types of reinforcement as a motivation factor for NSSI was found. Post-hoc tests revealed a significant difference between boys and girls when no positive peers' history is present with boys having lower ERS scores than girls, but no difference when both groups had friends engaging in self-injurious behavior. There was only moderate agreement between parents and their children in naming reasons for the current crisis involving NSSI.Conclusion: Emotional regulation, especially ER, has an influence on patients' acute psychiatric symptomatology and when experiencing an acute crisis should be brought into focus early at psychiatric assessment. A history of self-injurious behavior taken from patient's family members and close circle of friends and agreement on reasons for the crisis should be routinely included in the exploration of a patient presenting with self-injurious behavior.

Outreach Psychiatric Emergency Service

Crisis ◽  
2020 ◽  
Vol 41 (5) ◽  
pp. 375-382
Author(s):  
Remco F. P. de Winter ◽  
Mirjam C. Hazewinkel ◽  
Roland van de Sande ◽  
Derek P. de Beurs ◽  
Marieke H. de Groot
Keyword(s):  
General Practitioner ◽  
General Hospital ◽  
Suicidal Behavior ◽  
Emergency Service ◽  
Attempted Suicide ◽  
Emergency Services ◽  
Psychiatric Emergency ◽  
Psychiatric Emergency Services ◽  
Psychiatric Emergency Service ◽  
Suicidal Patients

Abstract. Background: Outreach psychiatric emergency services play an important role in all stages of a suicidal crisis; however, empirical assessment data are scarce. This study describes characteristics of patients assessed by these services and involved in suicidal crises. Method: During a 5-year period, detailed information from psychiatric emergency service assessments was recorded; 14,705 assessments were included. Characteristics of patients with/without suicidal behavior and with/without suicide attempts were compared. Outcomes were adjusted for clustering of features within individual patients. Results: Suicidal behavior was assessed in 32.2% of patients, of whom 9.2% attempted suicide. Suicidal behavior was most commonly associated with depression or adjustment disorder and these patients were referred to the service by a general practitioner or a general hospital, whereas those who attempted suicide were less likely to be referred by a general practitioner. Those who attempted suicide were more likely to be female and have had a referral by a general hospital. Self-poisoning by medication was the most common method of attempting suicide. Limitations: Bias could be due to missed or incomplete assessments. Primary diagnoses were based on clinical observation at the time of the assessment or on the primary diagnosis previously recorded. In addition, suicidal behavior or attempted suicide might have been underestimated. Conclusions: Suicidal behavior is commonplace in assessments by psychiatric emergency services. Suicidal patients with/without a suicide attempt differed with respect to demographic features, primary diagnoses, and referring entities, but not with respect to treatment policy. About 40% of the suicidal patients with/without an attempt were admitted following assessment.

scholarly journals Healthcare Utilization Due to Suicide Attempts among Homeless Youth in New York State

2021 ◽  
Author(s):  
Rie Sakai-Bizmark ◽  
Hiraku Kumamaru ◽  
Dennys Estevez ◽  
Emily H Marr ◽  
Edith Haghnazarian ◽  
...  
Keyword(s):  
Emergency Department ◽  
New York ◽  
Length Of Stay ◽  
Suicide Attempt ◽  
Healthcare Utilization ◽  
Regression Models ◽  
Homeless Youth ◽  
Suicide Attempts ◽  
New York State ◽  
Individual Characteristics

Abstract Suicide remains the leading cause of death among homeless youth. We assessed differences in healthcare utilization between homeless and non-homeless youth presenting to the emergency department or hospital after a suicide attempt. New York Statewide Inpatient and Emergency Department Databases (2009–2014) were used to identify homeless and non-homeless youth ages 10 to 17 who utilized healthcare services following a suicide attempt. To evaluate associations with homelessness, we used logistic regression models for mortality, use of violent means, intensive care unit utilization, log-transformed linear regression models for hospitalization cost, and negative binomial regression models for length of stay. All models were adjusted by individual characteristics with a hospital random effect and year fixed effect. We identified 18,026 suicide attempts with healthcare utilization rates of 347.2 (95% Confidence Interval [CI]: 317.5, 377.0) and 67.3 (95%CI: 66.3, 68.3) per 100,000 person-years for homeless and non-homeless youth, respectively. Length of stay for homeless youth was statistically longer than non-homeless youth (Incidence Rate Ratio 1.53; 95%CI: 1.32, 1.77). All homeless youth who visited the emergency department after a suicide attempt were subsequently hospitalized. This could suggest a higher acuity upon presentation among homeless youth compared with non-homeless youth. Interventions tailored to homeless youth should be developed.

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